Remote Physician Appeals Leader - Utilization Review

Temple-Health; 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 resource for medical necessity appeals and PAMA utilization reviews.

The role requires strong knowledge of Interqual criteria, hospital reimbursement, and experience with second/third level appeals and expert testimony in a managed care environment. Licensing in PA is required.

Qualifications

• Experience with Interqual Criteria Set and hospital reimbursement systems.
• Experience in second/third level appeals including expert witness work.
• Experience in a managed care environment.

Responsibilities

• Provides clinical expertise and guidance to Clinical Analysis and appeals team.
• Acts as the physician advisor for medical necessity appeals and for PAMA utilization reviews.
• Serves as a physician resource for regulatory and revenue cycle denial and appeals processes for hospital activity, including utilization review for all PAMA cases, all UM denials and appeals.

Skills

Interqual Criteria

Appeals expertise

Managed Care

Education

PA Medical Physician License

PA Osteopathic Physician License

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 resource for medical necessity appeals and PAMA utilization reviews.

The role requires strong knowledge of Interqual criteria, hospital reimbursement, and experience with second/third level appeals and expert testimony in a managed care environment. Licensing in PA is required.