Regional Physician Advisor Position (Eastern/Peninsula) Coastal Virginia Near the Beach
Core
Supports Clinical Revenue Cycle's Utilization Review and Denials/Appeals processes to determine appropriate levels of care, ensure compliant billing, and manage documentation integrity for hospital facilities.
Role type
Regional Physician Advisor (Utilization Review & Denials Management)
Builds
Compliant billing assignments and effective utilization of health care services
Domain
Healthcare / Clinical Revenue Cycle / Utilization Review
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Medical doctorate or Doctor of Osteopathy, Board certification in specialty, Active unrestricted state medical license, CMS regulatory guidance knowledge, Clinical documentation integrity, Hospital billing and coding processes, Case mix index and DRG assignments, Published leveling criteria (MCG/Interqual), EMR system proficiency
Preferred skills
5+ years clinical experience, 2+ years physician advisory experience, Hospital clinical experience
Responsibilities
Determine and secure appropriate level of care assignments, Assist with denials management, Support documentation integrity, Interface with hospital and medical staff leadership, Facilitate communication between Revenue Cycle and hospital facilities, Provide formal and informal education to medical staff
Seniority
Mid-Senior level, hands-on clinical advisor