Strategic Physician Advisor - Appeals & Utilization

Temple University Health System, Inc.; Philadelphia (Philadelphia County); On-site; USD 170,000 - 210,000; Full time

Job summary

Temple University Hospital seeks a Physician Advisor (FT, 40 hrs/wk) to provide clinical expertise to the Clinical Analysis and Appeals team. You will serve as the physician advisor for medical necessity appeals and for Pennsylvania Medical Assistance (PAMA) utilization reviews.

The role requires an MD or DO, strong knowledge of InterQual criteria, and experience with second/third level appeals and managed care. A PA Medical Physician License is required.

Qualifications

• General experience with InterQual Criteria Set and hospital reimbursement systems.
• Experience in second and third level appeals including expert witness.
• Experience in a managed care environment.
• Administrative leadership experience (preferred).

Responsibilities

• Serve as physician advisor for medical necessity appeals and for PAMA utilization reviews.
• Provide physician resource for regulatory and revenue cycle denial and appeals processes for hospital activity.

Skills

InterQual Criteria

Appeals expertise

Managed care experience

Regulatory knowledge

Education

MD/DO

Job description

Temple University Hospital seeks a Physician Advisor (FT, 40 hrs/wk) to provide clinical expertise to the Clinical Analysis and Appeals team. You will serve as the physician advisor for medical necessity appeals and for Pennsylvania Medical Assistance (PAMA) utilization reviews.

The role requires an MD or DO, strong knowledge of InterQual criteria, and experience with second/third level appeals and managed care. A PA Medical Physician License is required.