Physician Advisor - Sentara Obici Hospital

Physician Advisor

Location: Suffolk, VA

Work Shift: First (Days)

Overview:

The Physician Advisor conducts timely and compliant medical necessity reviews and assists with denials management in support of the centralized system Utilization Review (UR) process for Sentara hospital facilities. The Physician Advisor serves an important role in ensuring compliant hospital status/billing for hospital patients and strengthening relationships between Clinical Revenue Cycle, UR, hospital leadership, medical staff, and hospital ICM. The Physician Advisor interfaces directly with the medical staff, providing concurrent communication and education to attending physicians regarding recommended changes in hospital status, pertinent regulatory requirements and guidance impacting the determination, as well as documentation integrity to support medical necessity of services being delivered. Due to the collaborative and highly relational nature of this role, on-site (in-person) presence is integral. Coverage at additional sites may be required, including occasional in-person responsibilities.

Responsibilities:

Perform timely and compliant medical necessity reviews, providing clear documentation of the pertinent details of the case to satisfy regulatory requirements and directly communicate any necessary

Facilitate denials management through review of selected cases, conducting peer to peer discussion with third party payers as appropriate, and assisting with appeals letters

Work closely with hospital leadership, medical staff, and hospital ICM leaders to support system CPIs and initiatives

Attend and participate in Hospital UM committees at designated sites

Complete training and continuing education as deemed necessary

Attend and participate in educational presentations to medical staff, administration, leadership and peers

Additional functions as deemed appropriate and warranted

Education:

Completion of Medical Doctorate or Doctor of Osteopathy degree from an accredited medical school (Required)

Completion of an accredited residency training program (Required)

Licensure and Certification:

Active and unrestricted state of Virginia medical license (Required)

Board certification in specialty required at time of hire (Required)

Experience:

Minimum of 3 years of clinical experience, hospital clinical experience (Preferred)

Possess or acquire a working knowledge of CMS regulatory guidance and requirements as they pertain to UR and site of service decisions (Required)

Possess a working knowledge of clinical documentation integrity, hospital billing and coding processes and guidelines, case mix index, and DRG assignments (Required)

Familiarity with standard published leveling criteria such as MCG/Interqual and ability to apply professional judgment and patient-specific variables as may be necessary or justifiable (Required)

Familiarity with (Hospital) organization and case management operations (Required)

Excellent customer service and interpersonal skills. (Required)

Able to effectively present information, both formal and informal (Required)

Superb written and verbal communication skills (Required)

Ability to set and manage priorities (Required)

Demonstrate flexibility, teamwork, and a collaborative leadership style (Required)

Strong technical/computer skills and working knowledge of the system's EMR (Required)

Benefits:

Caring For Your Family and Your Career 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 Colleagues may have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met