PAS Physician Advisor Payer Peer to Peer (Part-time, Salaried)

R1 RCM•Jenkintown, PA

3d•$150,075 - $199,070•Remote

About The Position

At R1, we’re transforming how healthcare works by combining nearly two decades of revenue cycle expertise with advanced technology, including analytics, AI, intelligent automation and workflow orchestration. We pair that technology with the irreplaceable expertise of our people to help hospitals, health systems and medical groups improve financial performance, simplify administrative complexity and create better experiences for patients and providers. All Together Better defines our culture and the way we work. We’re a diverse, global team united by a shared mission to make healthcare work better for all. Across technology, operations and support functions, our people bring deep expertise, empathy and ingenuity to the work we do. Here, collaboration fuels progress, adaptability sparks innovation and every voice can help shape what’s next for R1 and the future of healthcare. 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.
Must work during pre-scheduled hours to be highly successful in this role (schedules are created about 30 days in advance).
Physicians should be highly capable of working independently with a high level of performance in a rapidly changing, fast-paced environment.
Successful physicians will need to meet quality and productivity standards.
Actively engage with attending physicians to discuss appropriate status as supported by documentation.
Make phone contact with utilization review team and/or case managers at client hospitals regarding submitted case determinations.
Provide written analysis of the case and perform case reviews across multiple specialties