PHYSICIAN ADVISOR - SUPPORT

Premier Health • Dayton, OH

3d

About The Position

The Physician Advisor – CDI, Coding & Quality is a clinical leader supporting Premier Health’s goals to advance documentation accuracy, revenue integrity, and quality performance across the health system. The role focuses on optimizing case mix index (CMI), risk adjustment, and clinical documentation excellence in collaboration with the CDI, Coding, and Quality teams.

The Physician Advisor provides expert second-level reviews, leads provider education, and partners with the CDI Manager, Coding Manager, and interdisciplinary teams to ensure documentation accurately reflects the clinical complexity, severity of illness, and quality outcomes of Premier Health’s patient population.

Requirements

• Doctor of Medicine (MD) or Doctor of Osteopathy (DO).
• Active Ohio medical license or eligibility for licensure.
• Minimum of 3 years of clinical practice experience.
• Excellent communication and teaching skills.
• Ability to interpret clinical and coding guidelines with precision.
• Proficiency with EHR systems.

Nice To Haves

• 1–2 years of prior involvement in CDI and/or quality improvement.
• Strong working knowledge of ICD-10, MS-DRG/APR-DRG systems, and risk adjustment models such as Vizient, CMS, and Elixhauser.
• Epic experience.

Responsibilities

• Provide secondary review of complex CDI and Coding queries escalated by the CDI and Coding teams.
• Review and resolve escalations involving query disagreement, clinical validation, or incomplete responses.
• Partner with the CDI Manager to establish standardized escalation criteria and ensure timely resolution of high-impact queries.
• Conduct focused second-look reviews of no-CC/MCC or CC-only cases to identify missed documentation opportunities and support CMI improvement.
• Serve as a liaison between CDI, Coding, and physician teams to promote consistent documentation practices.
• Meet one-on-one with providers to review query metrics, patterns, and opportunities for improvement.
• Deliver targeted education on documentation best practices, MCC/CC capture, and quality measure alignment.
• Participate in residency and faculty education, including lectures and QIPS elective rotations on CDI and professional billing documentation.
• Partner with the CDI Manager and Quality leadership to develop and distribute system-wide education tools and tip sheets.
• Analyze and communicate CMI trends by service line and support interventions aligned with Vizient benchmarks.
• Collaborate with the Digital Health team to refine dashboards and enable data-driven improvement strategies.
• Participate in pre-claim mortality and risk adjustment reviews, focusing on REM score optimization and accurate capture of clinical risk variables.
• Support PSI/HAC reviews from a CDI perspective in partnership with Quality and CDI teams.
• Serve as a clinical resource to CDI, Coding, and Quality departments on complex documentation and regulatory compliance questions.
• Partner with Digital Health to support AI-enabled CDI nudges, EHR workflow optimization, and system note-template refinement and creation for service lines.
• Contribute to system-wide initiatives related to mortality O/E, LOS O/E, cost efficiency performance, Vizient facility ranking, and Elixhauser risk adjustment methodologies.
• Achieve a sizeable conversion rate on escalated CDI/Coding queries.
• Demonstrate measurable CMI improvement in targeted service lines.
• Support system improvement in key Vizient metrics, including Mortality O/E, Cost O/E, and LOS O/E.
• Maintain a provider query agreement rate of at least 80% and consistent educational engagement.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Ph.D. or professional degree