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Job description
Clinical Analysis And Appeals Team Physician Advisor
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.
Education
Doctorate Degree Medicine or Osteopathic Medicine Required
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
Worksite address
philadelphia, PA, 19117, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.