Physician Advisor at AtlantiCare

Atlantic City, New Jersey, United States -

Full Time

Start Date

Immediate

Expiry Date

27 Jan, 26

Salary

0.0

Posted On

29 Oct, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Competency, Quality Improvement, Utilization Review, Denial Management, Medical Leadership, Documentation Excellence, Audit Management, Collaboration, Education, Performance Improvement, Healthcare Regulations, ICD-10 Preparation, Care Management, Data Analysis, Patient Care, Medical Expertise

Industry

Hospitals and Health Care

Description

TITLE: Physician Advisor JOB CODE: 1913 EXEMPT: X NON-EXEMPT: DATE: 7/14 REVISED: POSITION SUMMARY The Physician advisor provides high quality, cost-effective patient care that supports established specialty practice objectives and strategic organizational goals. The physician advisor works collaboratively with physician leaders, all medical staff, administration and staff to improve clinical outcomes. The Physician participates in quality improvement efforts organization-wide and plays an active role as a member of medical staff committees. The Physician maintains current technical knowledge and seeks educational and professional opportunities to enhance clinical practice and competency. The Physician assists the Senior Medical Director of Quality & Analytics and the AVP for Care Management in the carrying out of the System Utilization Review Plan. Included, but not limited to, concurrent and retrospective admission and continued stay reviews, denials and audit management, analyzing and leading performance improvement in utilization and denial management, and presentation at utilization review meetings and functions. The Physician partners with Health Information Management and the Clinical Documentation Excellence teams to develop standards and deliver education to providers for enhanced documentation in preparation for ICD-10 and beyond. The Physician partners with the Care Management team to provide medical leadership with regards to their work streams, interfaces with providers and finance, analytics capture and reporting and other opportunities for enhancement of the care management process. Other responsibilities include • Assist with external government and commercial audits by providing medical expertise and insight before and during the audit process. • Timely Admission and Continued Stay Reviews in MCCM • Prospective denial appeals as required • Provide assistance to the government audits/denials team and the Denials Specialist team working administrative denials • Physician oversight of the DNFB (discharged not final billed), CMS 1-day certification and insurance query processes, including necessary appeals • Commercial retrospective denials, including HAC (hospital-associated conditions) • Assist with clarification of order status for extended stay recovery, observation and admission • Provide physician advisement to the clinical documentation excellence current state query process, analysis and preparation and conversion to ICD-10 • Attend and participate in regular meetings of the Utilization Review Committee, Care Management teams, Clinical Documentation Excellence program, Finance Interdepartmental group, and ICD-10 workgroup. • Assist with insurer audits as they occur throughout the year QUALIFICATIONS EDUCATION: Graduate of an accredited school of medicine LICENSE/CERTIFICATION: Currently licensed to practice medicine with the State of New Jersey. Board Certification within specialty and membership on the staff of Atlantic City Medical Center. CDS and DEA registration unencumbered. EXPERIENCE: Completion of accredited residency program. Proficiency in Clinical Applications preferred at time of hire; incumbents within position will be trained appropriately and then skill will be required for this position within 30-60 days from date of hire. PERFORMANCE EXPECTATIONS The physician demonstrates the clinical competencies as established on the Assessment and Evaluation Tool. WORK ENVIRONMENT Potential for exposure to the hazards and risk of the hospital environment, blood borne pathogens, including exposure to infectious disease, hazardous substances, and potential injury. Essential functions of this position are listed on the Assessment and Evaluation Tool. REPORTING RELATIONSHIP This position reports to the Senior Medical Director of Quality & Analytics. The above statement reflect the general details considered necessary to describe the principle functions of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position.

Responsibilities

The Physician Advisor provides high-quality, cost-effective patient care while collaborating with various stakeholders to improve clinical outcomes. Responsibilities include participation in quality improvement efforts, utilization reviews, and assisting with audits and denials.