Regional Physician Advisor Position (Eastern/Peninsula) Coastal Virginia Near the Beach
On-site · Williamsburg, Virginia, United States
Job Summary
Regional Physician Advisor supports the Clinical Revenue Cycle’s Utilization Review and Denials/Appeals processes to determine and secure appropriate level of care assignments for compliant billing, assists with denials management, supports documentation integrity as it pertains to accurate coding capture, and interfaces with hospital and medical staff leadership to facilitate communication between Revenue Cycle leadership and hospital facilities. Provides formal and informal education to medical staff, supports organizational goals for efficient utilization of health care services, and applies CMS regulatory guidance to UR and site-of-service decisions. On-site leadership presence in Williamsburg, VA with collaboration across Sentara Williamsburg Regional Medical Center and affiliated facilities. Requires MD/DO, Virginia license, board certification, 5+ years clinical experience, 2+ years physician advisory experience, and strong communication and analytical skills.
Required Qualifications
- Completion of Medical doctorate or Doctor of Osteopathy degree from an accredited medical school
- Completion of an accredited residency training program
- Minimum of 5 years of clinical experience (hospital clinical experience strongly preferred)
- Minimum of 2 years of physician advisory experience strongly preferred
- Active and unrestricted state Virginia medical license
- Board certification in specialty required at time of hire
- Posess or acquire a thorough understanding of CMS regulatory guidance and requirements as they pertain to UR and site of service decisions
- Possess a working knowledge of clinical documentation integrity, hospital billing and coding processes and guidelines, case mix index, and DRG assignments
- Familiarity with standard published leveling criteria such as MCG/Interqual
- Familiarity with (Hospital) organization and case management operations
- Excellent customer service and interpersonal skills
- Able to effectively present information, both formal and informal
- Superb written and verbal communications skills
- Strong organizational and analytic skills, and ability to set and manage priorities
- Demonstrate flexibility, teamwork, and a collaborative leadership style
- Strong technical/computer skills and working knowledge of the system’s EMR
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