Physician Advisor M-F

Job Description Description:Brundage Group provides revenue cycle solutions and physician advisory services that empower hospitals nationwide to capture earned revenue, ensure compliance, and improve operational efficiency. We blend clinical thought leadership with cutting-edge technology to help hospitals stay viable to continue serving our communities.The Physician Advisor (PA) will drive quality performance across the organization by communicating with hospital physicians, utilization management, case management, CDI, the denials team, and quality staff. The PA conducts case reviews to ensure compliance, appropriate and accurate clinical documentation, and appropriate utilization of health care services. The PA will meet with hospital personnel and medical staff when needed to provide education and expertise. The PA acts as a consultant and resource for attending physicians regarding appropriate status, utilization of resources, need for continued hospitalization, compliance concerns and tracking and reporting of quality and complications. The PA will also interact with medical directors of third-party payers to discuss the medical necessity, utilization of resources and appropriate level of care.Requirements:Utilization Management FunctionsReviews medical records of patients identified by the UM team or as requested by the healthcare teamPerform status determinations including 2nd level reviews and continued stay reviews for traditional Medicare patients and all other payorsReview Code 44 casesAssist with length of stay managementWork with case management and the interdisciplinary team to ensure appropriate continuity of care and reduce readmissionsCommunicate with the medical staff through secure email, secure texting applications, phone calls and face to face interactions to relay important information and provide educationAct as a liaison between Utilization Management/Case Management and providers to collaborate on appropriate plans of careReview and suggest improvements related to resource allocationOptimize coordination of care processesProvide guidance to ED Physicians and the UM/CM team regarding alternatives to acute careCDI FunctionsReview documentation for clinical validity of diagnosesSupport query response and query constructionEducate physicians on documentation best practicesProvide feedback to clinical providersAssist with pre-bill DRGQuality FunctionsReview documentation to support quality metricsEducate providers on how quality is tracked and common pitfallsReview PSIs for appropriate assignment of complicationsDenials Management FunctionsReview denials and author appeal letters as neededPerform peer to peers with payorsAct as a liaison with payors to facilitate approvals and prevent denials or carved out days when appropriateKNOWLEDGE, SKILLS, AND ABILITIES: Abilities may be accessed through written, verbal, and other evaluation methods.Expertise in Utilization Management preferredStrong interpersonal skillsExcellent written and verbal communication skillsAbility to work independentlyAbility to build relationships with key hospital team membersWORK EXPERIENCE, EDUCATION AND CERTIFICATIONS: List preferred/required work experience, education, and certificationsMD or DOCurrent, unrestricted medical license in state of residenceDemonstrated ability to build rapport with medical staff and hospital leadershipStrong computer skills and working knowledge of EMRsPrior Physician Advisor experience or at least 3 years of clinical experience in a hospital-based settingPreferred Qualifications:Board Certified / EligibleCCDS or CDIPCCSCHCQM certification (ABQAURP)WORKING CONDITIONS AND PHYSICAL REQUIREMENTS:Conditions typically associated with an office environment. While performing the essential duties andresponsibilities, the employee is regularly required to talk or hear. May be frequently required to sit, stand orwalk. Moderate to prolonged reading, typing, and computer work. Ability to perform tasks involving physicalactivity that may include lifting 25 pounds. Subject to exposure to all environmental hazards associated withhealthcare and office work.