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Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Summary:

The Physician Advisor is a key member of the UPHS leadership team and assists the organization in attaining improved financial, quality, and patient flow measures by ensuring efficient and effective utilization of health care services. The Physician Advisor role includes teaching, consulting, and advising case management, utilization review and provider staff. The physician advisor works with the. clinical documentation integrity team to improve the accuracy and completeness of medical record documentation, ensuring the record reflects patient accuracy, and supports accurate coding, risk adjustment, and quality reporting. The Physician Advisor evaluates physician practice patterns, has expertise in utilization of resources, medical necessity, levels of care, care progression, patient readmissions, and denial management. The Physician Advisor partners with the managed care and compliance departments to ensure governmental and private payer regulations are met. The physician advisor role also assists with the documentation in the EMR and participates in strategic initiatives.

Responsibilities:

+ The Physician Advisor collaborates closely with the medical staff, resident physician house staff, faculty and all areas of resource management, case management, social services, and utilization management to develop and implement methods/action plans that optimize the use of hospital services for all patients while also ensuring the quality of care provided.

+ Acting as the physician champion, the physician advisor consults with the interdisciplinary team, particularly when difficult issues arise, and has critical conversations concerning resource utilization and medical necessity.

+ Responsible for denial management, the physician advisor maximizes real- time denial prevention strategies and conducts peer reviews with insurance companies for denied cases and ensures denials are resolved prior to claim submission. He/she implements an appeal strategy for cases when the insurance carrier upholds the denial.

+ As appropriate, the physician advisor serves as an educational resource for hospital staff regarding medical necessity, regulations, rules of reimbursement, patient flow, length of stay, readmissions, value- based purchasing and other utilization issues.

+ Bridges communication between the CDI team and clinical staff to ensure accurate reimbursement and compliance. Provides query support and review and helps to resolve any documentation discrepancies.

+ The Physician Advisor tracks daily interventions and prepares monthly reports defining outcomes and payer trends.

+ Fosters a partnership between compliance, managed care, and the health plans in accordance with contractual agreements, policies and state and federal regulations.

+ Active member of the Managed Care and UM Committees; identifies and presents cases for review.

+ Assists the HIM, CDI, and compliance departments in the interpretation of ICD-10 codes, clinical pathophysiology, and audit results.

+ Meets/exceeds Penn Medicine’s strategic initiatives.

Credentials:

+ Medical Doctor

+ Licensed in the state of Pennsylvania

Education/Experience:

+ Doctorate Degree - Science Medicine or Surgery with 3+ years of clinical experience

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

REQNUMBER: 289230