Physician Advisor - PRN

About the role

Job Summary The Physician Advisor is a key member of the NGHS Revenue Cycle team and is charged with meeting the organization's goals and objectives for assuring effective, efficient, and compliant utilization of health care services. The role includes significant educational and supportive services, working with providers and hospital staff. The Physician Advisor shall develop expertise on matters regarding physician practice patterns, over and under utilization of resources, medical necessity, levels of care, care progression, denial management, compliance with governmental and private payor regulations, and documentation requirements. The role works closely with the entire medical staff, including resident physician house staff, all areas of resource management, Utilization Management and Case Management to develop and implement methods to optimize use of hospital services for all patients while also ensuring the quality of care provided. Concurrent communication with medical staff will be crucial to ensure timely documentation in the medical record, to include status orders that reflect the appropriate level of care. Minimum Job Qualifications Licensure or other certifications: Hold an unrestricted medical license in the state of Georgia. Member of the NGHS medical staff. Educational Requirements: Medical Degree, Board certification required Minimum Experience: Five (5) - seven (7) years physician practice experience, 10+ preferred. Possess or acquire solid foundation, knowledge an/or experience in areas of Utilization Management and Quality Improvement. Possess working knowledge of UR operations, along with standard UR metrics and payor methodologies. Experience and knowledge in healthcare Federal and State regulations is required. Strong computer skills and working knowledge of the EMR required. Other: Preferred Job Qualifications Preferred Licensure or other certifications: Preferred Educational Requirements: Member of the American College of Physician Advisors (ACPA). Preferred Experience: Other: Job Specific and Unique Knowledge, Skills and Abilities Working knowledge of the Revenue Cycle processes and goals. Excellent customer service and interpersonal skills. Able to effectively present information, both formal and informal. Strong written and verbal communication skills with all levels of internal and external customers. Persuasiveness and leadership to obtain action, consent, agreement, or approval. May involve difficult negotiations or a high degree of diplomacy and judgement to achieve results. Requires an innovative, creative thinker to initiate long range programs, goals, policies and procedures. Ability to foresee and assess potential problems and to plan alternative solutions. Strong analytical skills. Strong organizational skills and ability to set priorities and multi-task, demonstrates flexibility, teamwork, and is accustomed to change in the healthcare environment. Demonstrates ability to drive results and produce outcomes. Working knowledge of criteria for Medicare, Medicaid, HMO and private insurance coverage; knowledgeable of Federal and State regulations and hospital finance. Ability to work collaboratively; ability to network and access resources as needed by team. Obtains familiarity and working knowledge of standard published criteria such as InterQual/MCG and applies professional judgement and patient specific variables as may be necessary of justifiable. Functions with little direct supervision in accordance with the goals set forth by Administrators and Department Directors. Essential Tasks and Responsibilities Participation and active role in the Utilization Review Committee to include review of data related to utilization and presentation of findings with recommendations for improvement. Support physician education and collaboration, including but not limited to the following: Provide education to physicians and other clinicians related to regulatory requirements, appropriate utilization of hospital services, community resources and alternative levels of care. Create action plans to address issues. Provide concurrent physician coaching and on-going education on appropriate documentation to support level of care and care standards. Provide regular feedback to physicians and all other stake holders regarding level of care, length of stay and potential quality issues. Facilitate, mentor, and educate other physicians regarding payer requirements. Contacts physicians in a timely manner to resolve delays and achieve positive outcomes. Demonstrates positive outcomes through interventions with attending or consulting physicians that impact status determination, delay care and affect LOS, or avoidable days. Participates in Medical Staff education on Healthcare Payme