PAS Physician Advisor Payer Peer to Peer

R1 RCM•Jenkintown, PA

22h•Remote

About The Position

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our Physician Advisor, you will help our client facilities navigate the path to compliant revenue by reviewing payor peer-to-peer cases. Every day. You will review cases for which authorization has been denied, evaluating if the proper documentation was available for the admission status, procedure, and care setting that was requested. You will also advise our clients regarding the appropriateness of the request based on available documentation, as well as discuss the cases with medical directors from the payor side. To thrive in this role, you must have strong clinical knowledge across multiple clinical areas and be capable of working independently with a high level of performance in a rapidly changing, fast-paced environment. Proficiency in basic computer skills is essential for excelling in this remote position.

Requirements

Active, unrestricted MD or DO medical licensure
Minimum 3+ years of clinical experience post-residency completion
Proficiency in basic computer skills

Nice To Haves

Strong clinical knowledge across multiple clinical areas

Responsibilities

Addresses the following issues: authorization requested, documentation support or lack of support for that authorization, evidence-based criteria for that support, and complex clinical evaluation of the request as a whole.
Review and respond to the payor and customer in a timely manner.
Actively engage with payor medical directors to discuss appropriate authorization status as supported by documentation.
Provide written analysis of the case and perform case reviews across multiple specialties.
Serve as a clinical resource to medical and case management staff by providing identification, facilitation, and resolution of documentation and utilization issues.