PHYSICIAN ADVISOR (FT; REMOTE) - Temple University Hospital
Provides clinical expertise and guidance to Clinical Analysis and appeals team. Acts as the physician advisor for medical necessity appeals and for the Pennsylvania Medical assistance (PAMA) utilization reviews. Acts as a physician resource for the regulatory and revenue cycle denial and appeals processes for hospital activity, including utilization review for all PAMA cases, all UM denials and appeals.
Experience General Experience and strong working knowledge of the Interqual Criteria Set and hospital reimbursement systems Required General Experience in a role dealing with Second and Third level appeals processes including direct experience with being an expert witness Required General Experience in a managed care environment Required General Experience in an Administrative Leadership role Preferred Licenses PA Medical Physician License Required or PA Osteopathic Physician Required
PA Medical or Osteopathic Physician license required; experience with Interqual Criteria Set, hospital reimbursement systems, second/third level appeals, expert witness, managed care; administrative leadership preferred.
Key Responsibilities
- providing clinical expertise
- reviewing medical necessity
- supporting appeals processes
Skills & Tools
Interqual Criteria Set
Job Details
- Category: Healthcare Services - Advanced Practice
- Seniority: Senior Level
- Commitment: Full Time
- Workplace: Remote — Philadelphia, Pennsylvania, United States
- Languages: English
About Temple Health
A healthcare system providing hospital and physician services. — Industry: Healthcare