PHYSICIAN ADVISOR (FT; REMOTE) - Temple University Hospital

Temple Health • Philadelphia, PA

21d • Remote

About The Position

Provides clinical expertise and guidance to the Clinical Analysis and appeals team. Acts as the physician advisor for medical necessity appeals and Pennsylvania Medical Assistance (PAMA) utilization reviews. Serves as a physician resource for regulatory and revenue cycle denial and appeals processes related to hospital activity, including utilization review for all PAMA cases and all utilization management (UM) denials and appeals.

Requirements

• General experience and strong working knowledge of the InterQual Criteria Set and hospital reimbursement systems.
• General experience in a role involving second- and third-level appeals processes, including direct experience as an expert witness.
• General experience in a managed care environment.
• Pennsylvania medical physician license or Pennsylvania osteopathic physician license.

Nice To Haves

• General experience in an administrative leadership role.

Responsibilities

• Provide clinical expertise and guidance to the Clinical Analysis and appeals team.
• Serve as the physician advisor for medical necessity appeals and PAMA utilization reviews.
• Provide physician expertise for regulatory and revenue cycle denial and appeals processes for hospital activity.
• Conduct utilization review for all PAMA cases and all UM denials and appeals.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed