Remote Physician Advisor for Medical Necessity & Appeals

Temple University Health System; Philadelphia (Philadelphia County); Remote; USD 180,000 - 240,000; Full time

Job summary

Temple University Hospital is seeking a Physician Advisor (FT; Remote) to provide clinical expertise to the Clinical Analysis and appeals team and to serve as the physician advisor for medical necessity appeals and PAMA utilization reviews. The role requires a Doctorate in Medicine or Osteopathic Medicine, strong Interqual criteria knowledge, and experience with managed care appeals.

It includes acting as a resource for regulatory and revenue cycle denial and appeals processes in a hospital

Qualifications

• Doctorate in Medicine or Osteopathic Medicine required.
• Strong working knowledge of the Interqual Criteria Set.
• Experience with second/third level appeals and expert witness roles in a managed care environment.

Responsibilities

• Provide clinical expertise and guidance to the Clinical Analysis and appeals team.
• Act as the physician advisor for medical necessity appeals and for PAMA utilization reviews.
• Serve as physician resource for regulatory and revenue cycle denial/appeals processes for hospital activity.

Skills

Interqual criteria

Appeals expertise

Regulatory knowledge

Managed care experience

Education

Doctorate Degree in Medicine or Osteopathic Medicine

Job description

Temple University Hospital is seeking a Physician Advisor (FT; Remote) to provide clinical expertise to the Clinical Analysis and appeals team and to serve as the physician advisor for medical necessity appeals and PAMA utilization reviews. The role requires a Doctorate in Medicine or Osteopathic Medicine, strong Interqual criteria knowledge, and experience with managed care appeals.

It includes acting as a resource for regulatory and revenue cycle denial and appeals processes in a hospital