RCS-Physician Advisor

Indiana University Health System; Indiana (PA); Sur place; USD 180 000 - 210 000; Plein temps

Résumé du poste

Indiana University Health is seeking a Physician Advisor to help optimize hospital services and medical necessity reviews. This role acts as a liaison among Revenue Cycle Services, hospital administration, and clinical staff.

You will provide clinical expertise to the Utilization Management team, ensure HIPAA confidentiality, and lead data-driven analyses to improve care and compliance. Join a system that values mission, excellence and teamwork, and impact outcomes for Hoosiers.

Qualifications

• Medical degree and board certification in a recognized medical or surgical specialty required.
• Relevant experience preferred.
• Current licensure to practice medicine.
• Clinical experience in a hospital setting.
• Understanding of clinical utilization review and healthcare regulations.
• Knowledge of current medical coding and billing practices.
• Excellent communication and interpersonal skills.
• Strong leadership abilities and a collaborative approach to problem-solving.
• Knowledge in Medical Necessity, healthcare regulatory requirements, and medical coding and billing.

Responsabilités

• Liaise between Revenue Cycle, administration and clinical staff to optimize hospital services.
• Support Utilization Management with authorizations, reviews, and payor denials.
• Maintain HIPAA confidentiality and handle records with discretion.
• Analyze problems and opportunities to inform decisions.
• Collaborate with teams; mentor staff and share best practices.
• Exercise independent judgment when facing unexpected problems.

Connaissances

Excellent communication

Leadership abilities

Collaboration

Critical thinking

Independent judgment

Medical terminology

Healthcare regulations knowledge

Formation

Medical degree

Board certification in medical/surgical specialty

Description du poste

RCS-Physician Advisor

Our leaders shape strategic initiatives, develop passionate teams, and work to improve health outcomes.They advance our mission and exemplify excellence, compassion, teamwork and purpose in all that they do.

Description

Acts as a liaison between IU Health Revenue Cycle Services, hospital administration, and clinical staff, aiding in the optimization of hospital services, resource utilization, and medical necessity reviews. Provides clinical expertise and support to the IUH Utilization Management team and their work related to authorizations, concurrent reviews and payor denials.

Responsibilities

• Connect to Promise - Demonstrates a commitment to IU Health's mission, vision, and values by exhibiting behaviors and delivering results that align with the strategic direction of the organization. Ensure IU Health is working toward its vision of improving the health of all Hoosiers by providing the best care for each person as we practice our values of purpose, excellence, compassion and team.
• Ethical Practice - Demonstrates the highest level of confidentiality standards in handling of customer relations, medical and prescription records and Health Insurance Portability and Accountability Act (HIPAA) compliance. Maintains confidentiality as appropriate, earns trust and respect of others, and exhibits behaviors that express the ethical practice of a healthcare organization. Mitigates unintended consequences through careful analysis and observation of business practices. Reports and responds immediately to unethical behavior or conflicts of interest.
• Analysis - Thoroughly analyzes problems and opportunities, and their impact on the business. Takes into account all fact-based and stakeholder information in order to evaluate alternatives and make judgment-rich decisions. Probes symptoms to determine the underlying causes of problems and then integrates information from a variety of sources to arrive at optimal solutions.
• Business Acumen - Exhibits working knowledge of the department and function and how it is structured. Structures work to align with the goals and operations of department and function.
• Collaboration - Coordinates job activities with team members and leaders as required. Finds workable solutions that can be leveraged by other team members. Seeks out and shares best practices for performing job duties. Engages, guides and mentors other team members as needed.
• Critical Thinking - Leverages curiosity and insights to explore rationale behind decision-making. Connects pieces of information from various sources to improve problem solving capabilities and recommendations. Actively distinguishes questions, problems, and conflict. Combines existing knowledge and on-the-job experiences to ensure best practices are being implemented in day-to-day work.
• Independent Judgment - Exhibits sound professional judgment and diplomacy in handling unexpected problems and frequent interruptions that require immediate action or attention.

Candidate Qualifications

Candidates for the position will be evaluated according to the following criteria and competencies:

• Medical degree and board certification in a recognized medical or surgical specialty required.
• Relevant experience preferred.
• Current licensure to practice medicine.
• Clinical experience in a hospital setting.
• Understanding of clinical utilization review and healthcare regulations.
• Knowledge of current medical coding and billing practices.
• Excellent communication and interpersonal skills.
• Strong leadership abilities and a collaborative approach to problem-solving.
• Requires along with knowledge in the areas of Medical Necessity, health care regulatory requirements, and an understanding of medical coding and billing.

Indiana University Health is unlike any other healthcare system and we're looking for team members who share the things that matter most to us. IU Health leaders play a crucial role in advancing the mission of our organization and inspiring teams to make a meaningful difference in the lives of patients. As one of Indiana’s largest employers and the most comprehensive medical system in the state, our vision is to lead the transformation of healthcare through quality, innovation and education, and make Indiana one of the nation’s healthiest states.

IU Health is the largest health system in Indiana with nearly 40,000 team members, 15 hospitals and $8.64 billion in operating revenue. The system’s programs in cancer, cardiovascular, neuroscience, orthopedics, pediatrics and transplants have received national recognition for quality patient care. IU Health, in partnership with the Indiana University School of Medicine, bring together highly skilled physicians, researchers, and educators into close collaboration to provide world-class care for children and adults and improve the health of patients and communities across Indiana.

Indiana University Health is dedicated to a fair hiring process and is committed to equal opportunity and nondiscrimination for all individuals, regardless of age, color, disability, ethnicity, marital status, national origin, race, religion, gender identity, expression, sexual orientation, or veteran status.