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

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:

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

Sentara Obici Hospital, a 175-bed state-of-the-art facility, is located on Godwin Boulevard in Suffolk, VA. Our full-service hospital continues a legacy of providing residents of Western Tidewater with high-quality, patient-centered care. As a recognized accredited Primary Stroke Center, and Magnet hospital for nursing excellence, the hospital specializes in orthopedic and spine, heart and vascular, advanced imaging, gynecological and comprehensive breast services, behavioral health, maternity, weight loss surgery, and a heartburn treatment center.

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission "to improve health every day," this is a tobacco-free environment.

Sentara Health employs associates in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.