Physician Advisor
3 weeks ago
The Physician Advisor at Covenant HealthCare serves as a liaison between physicians, Utilization Management (UM), and Clinical Documentation Integrity (CDI) teams, revenue cycle, and hospital administration. This role requires collaboration with physicians and hospital staff to advise on best practices, ensuring compliance with payer rules, CMS regulations, and hospital contractual relationships. The ideal candidate will demonstrate excellent customer service, a positive attitude, and the ability to remain current on regulatory changes.
Key Responsibilities:
Maintain denial queues and perform peer-to-peer conversations with Medicare advantage, Medicaid health plans, and commercial payers.
Conduct primary medical necessity reviews on cases in observation status and review Code 44 cases.
Maintain the Physician Advisor work queue, providing feedback on inpatient and observation cases, and conduct second-level medical necessity reviews for cases not meeting first-level inpatient criteria.
Complete the Medicare work queue by evaluating short-stay Medicare FFS cases for self-audit and billing of Part A services, and follow up on query escalations.
Assist the manager with CDI/UM education, collaborate on CDI denials, and provide education to physicians and APPs at educational meetings.
Requirements:
Graduate of an accredited medical school required, with a current State of Michigan medical license and completion of a specialty residency.
Minimum of 3 years of experience in a hospital-based practice setting, with board certification preferred.
Strong computer skills, including application and use of the internet, EPIC, Excel, PowerPoint, and Word, with the ability to task-switch and prioritize assignments based on revenue deadlines.
Demonstrated ability to develop relationships, build rapport with medical staff and hospital leadership, and deliver high-quality, cost-effective, efficient patient care services.
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