Physician Advisor

Ensemble Health Partners•Work at Home - Texas - Other, TX

7d•Remote

About The Position

Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation. Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.

Requirements

Reside and be authorized to work within the United States.

Responsibilities

Rendering compliant status determinations for hospitalized patients.
Conducting peer-to-peer reviews with payors' medical directors.
Serving as a subject matter expert on utilization management (UM) issues.
Reviewing short inpatient stays and observation patients daily.
Building strong relationships with medical staff and leadership to gain support for UM initiatives.
Attending UM committees.
Assisting with denials and appeals.
Educating medical staff on UM topics.
Partnering with utilization review nurses, insurance authorization staff, and Case Management to strengthen UM processes.
Tracking denial trends to help the team adapt to evolving payor challenges.