Regional Physician Advisor Position (Eastern/Peninsula) Coastal Virginia Near the Beach

Sentara Health

87d

About The Position

Sentara Health is seeking to hire a qualified individual to join our team as Regional Physician Advisor. The Regional Physician Advisor supports the Clinical Revenue Cycle’s Utilization Review and Denials/Appeals processes to determine and secure appropriate level of care assignments to ensure compliant billing, assist with denials management, support documentation integrity as it pertains to accurate coding capture. The Regional Physician Advisor interfaces with hospital and medical staff leadership, facilitating communication between Revenue Cycle leadership and processes and the hospital facilities and championing processes and initiatives. This role is responsible for supporting and meeting the Clinical Revenue Cycle functions organizational goals and objectives for assuring the effective, efficient utilization of health care services.

Requirements

• Completion of Medical doctorate or Doctor of Osteopathy degree from an accredited medical school.
• Completion of an accredited residency training program.
• Minimum of 5 years of clinical experience, hospital clinical experience strongly preferred.
• Minimum of 2 years of physician advisory experience strongly preferred.
• Active and unrestricted state Virginia medical license.
• Board certification in specialty required at time of hire.
• Thorough understanding of CMS regulatory guidance and requirements as they pertain to UR and site of service decisions.
• Working knowledge of clinical documentation integrity, hospital billing and coding processes and guidelines, case mix index, and DRG assignments.
• Familiarity with standard published leveling criteria such as MCG/Interqual.
• Familiarity with hospital organization and case management operations.
• Excellent customer service and interpersonal skills.
• Ability to effectively present information, both formal and informal.
• Superb written and verbal communications skills.
• Strong organizational and analytic skills, and ability to set and manage priorities.
• Demonstrate flexibility, teamwork, and a collaborative leadership style.
• Strong technical/computer skills and working knowledge of the system’s EMR.
• Ability to provide a consistent on-site presence at assigned sites.

Responsibilities

• Support the Clinical Revenue Cycle’s Utilization Review and Denials/Appeals processes.
• Determine and secure appropriate level of care assignments.
• Ensure compliant billing and assist with denials management.
• Support documentation integrity as it pertains to accurate coding capture.
• Interface with hospital and medical staff leadership.
• Facilitate communication between Revenue Cycle leadership and hospital facilities.
• Champion processes and initiatives.
• Assist with both formal and informal education of medical staff.

Benefits

• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down – $10,000
• Reimbursement for certifications and free access to complete CEUs and professional development
• Pet Insurance
• Legal Resources Plan
• Annual discretionary bonus opportunity.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Ph.D. or professional degree
• Number of Employees: 5,001-10,000 employees