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PHYSICIAN ADVISOR - FULL TIME at Temple Health System

Philadelphia, Pennsylvania, United States -

Full Time

Start Date

Immediate

Expiry Date

25 Dec, 25

Salary

0.0

Posted On

26 Sep, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Expertise, Medical Necessity Appeals, Utilization Review, Regulatory Compliance, Revenue Cycle Management, Interqual Criteria Set, Managed Care, Administrative Leadership, Expert Witness, Second Level Appeals, Third Level Appeals, Hospital Reimbursement Systems, PAMA Utilization Reviews, UM Denials, Appeals Processes

Industry

Hospitals and Health Care

Description

Provides clinical expertise and guidance to Clinical Analysis and appeals team. Acts as the physician advisor for medical necessity appeals and for the Pennsylvania Medical assistance (PAMA) utilization reviews. Acts as a physician resource for the regulatory and revenue cycle denial and appeals processes for hospital activity, including utilization review for all PAMA cases, all UM denials and appeals. Education Doctorate Degree Medicine or Osteopathic Medicine Required Experience General Experience and strong working knowledge of the Interqual Criteria Set and hospital reimbursement systems Required General Experience in a role dealing with Second and Third level appeals processes including direct experience with being an expert witness Required General Experience in a managed care environment Required General Experience in an Administrative Leadership role Preferred Licenses PA Medical Physician License Required or PA Osteopathic Physician Required

Responsibilities

Provides clinical expertise and guidance to the Clinical Analysis and appeals team. Acts as the physician advisor for medical necessity appeals and for the Pennsylvania Medical Assistance utilization reviews.