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- Tasks: Conduct medical necessity reviews and assist with denials management in a hospital setting.
- Company: Sentara Health is a leading healthcare provider dedicated to improving health every day.
- Benefits: Enjoy medical, dental, vision plans, tuition assistance, and generous paid time off.
- Why this job: Join a collaborative team making a real impact on patient care and hospital operations.
- Qualifications: Must have a medical degree, active Virginia license, and 3 years of clinical experience.
- Other info: Diversity and inclusion are core values; this is a tobacco-free workplace.
The predicted salary is between 36000 - 60000 £ per year.
2 days ago Be among the first 25 applicants
Overview:
The On-Site Physician Advisor (OSPA) conducts timely and compliant medical necessity reviews and assists with denials management (facilitating and completing peer to peers, writing appeal letters) in support of the centralized system Utilization Review (UR) process for Sentara hospital facilities. The Physician Advisor serves an important role in ensuring compliant hospital status/billing for hospital patients and strengthening relationships between Clinical Revenue Cycle, UR, hospital leadership, medical staff, and hospital ICM. The Physician Advisor interfaces directly with the medical staff, providing concurrent communication and education to attending physicians (and their APCs) regarding recommended changes in hospital status, pertinent regulatory requirements and guidance impacting the determination, as well as documentation integrity to support medical necessity of services being delivered.
City/State
Norfolk, VA
Work Shift
First (Days)
Overview:
The On-Site Physician Advisor (OSPA) conducts timely and compliant medical necessity reviews and assists with denials management (facilitating and completing peer to peers, writing appeal letters) in support of the centralized system Utilization Review (UR) process for Sentara hospital facilities. The Physician Advisor serves an important role in ensuring compliant hospital status/billing for hospital patients and strengthening relationships between Clinical Revenue Cycle, UR, hospital leadership, medical staff, and hospital ICM. The Physician Advisor interfaces directly with the medical staff, providing concurrent communication and education to attending physicians (and their APCs) regarding recommended changes in hospital status, pertinent regulatory requirements and guidance impacting the determination, as well as documentation integrity to support medical necessity of services being delivered.
As this role’s duties include significant interpersonal and relational aspects in addition to regulatory training and licensing requirements, an active and unrestricted Virginia medical license and board-certified status at the time of hire are required, as well as superb interpersonal and communication skills. Due to the collaborative and highly relational nature of this role, on-site (in person) presence is integral. Coverage at additional sites may be required, including occasional in-person responsibilities. The position reports to the Director of Regional Physician Advisors to Clinical Revenue Cycle.
- Perform timely and compliant medical necessity reviews, providing clear documentation of the pertinent details of the case to satisfy regulatory requirements and directly communicating any necessary
- Facilitate denials management through review of selected cases, conducting peer to peer discussion with third party payers as appropriate, and assisting with appeals letters
- Work closely with hospital leadership, medical staff, and hospital ICM leaders to support system CPIs and initiatives
- Attend and participate in Hospital UM committees at designated sites
- Complete training and continuing education as deemed necessary
- Attend and participate in educational presentations to medical staff, administration, leadership and peers
- Additional functions as deemed appropriate and warranted
Minimum Requirements:
- Completion of Medical doctorate or Doctor of Osteopathy degree from an accredited medical school
- Completion of an accredited residency training program
- Minimum of 3 years of clinical experience, hospital clinical experience strongly preferred
- Active and unrestricted state Virginia medical license
- Board certification in specialty required at time of hire
- Possess or acquire a working knowledge 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 and ability to apply professional judgment and patient specific variables as may be necessary or justifiable
- 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
- 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
Benefits: Caring For Your Family and Your Career
- Medical, Dental, Vision plans
- Adoption, Fertility and Surrogacy Reimbursement up to $10,000
- Paid Time Off and Sick Leave
- Paid Parental & Family Caregiver Leave
- Emergency Backup Care
- Long-Term, Short-Term Disability, and Critical Illness plans
- Life Insurance
- 401k/403B with Employer Match
- Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
- Student Debt Pay Down – $10,000
- Reimbursement for certifications and free access to complete CEUs and professional development
- Pet Insurance
- Legal Resources Plan
- Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission “to improve health every day,” this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
Seniority level
-
Seniority level
Not Applicable
Employment type
-
Employment type
Full-time
Job function
-
Job function
Health Care Provider
-
Industries
Hospitals and Health Care
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Physician Advisor - Sentara Princess Anne employer: Sentara Health
Contact Detail:
Sentara Health Recruiting Team
StudySmarter Expert Advice 🤫
We think this is how you could land Physician Advisor - Sentara Princess Anne
✨Tip Number 1
Network with professionals in the healthcare field, especially those who work at Sentara or similar organisations. Attend relevant conferences or seminars where you can meet potential colleagues and learn more about the role of a Physician Advisor.
✨Tip Number 2
Familiarise yourself with the latest CMS regulatory guidance and requirements related to Utilisation Review. This knowledge will not only help you in interviews but also demonstrate your commitment to staying updated in the field.
✨Tip Number 3
Prepare for potential interview questions by practising how you would handle specific scenarios related to medical necessity reviews and denials management. Use examples from your past experience to illustrate your problem-solving skills.
✨Tip Number 4
Showcase your interpersonal and communication skills during any interactions with the hiring team. Since this role involves significant collaboration with medical staff and hospital leadership, demonstrating your ability to communicate effectively is crucial.
We think you need these skills to ace Physician Advisor - Sentara Princess Anne
Some tips for your application 🫡
Tailor Your CV: Make sure your CV highlights relevant clinical experience, particularly in hospital settings. Emphasise your medical qualifications, board certification, and any specific training related to Utilization Review (UR) processes.
Craft a Compelling Cover Letter: In your cover letter, explain why you are interested in the Physician Advisor role at Sentara Princess Anne. Discuss your understanding of the importance of medical necessity reviews and how your skills align with the responsibilities outlined in the job description.
Highlight Interpersonal Skills: Given the collaborative nature of the role, be sure to showcase your superb interpersonal and communication skills. Provide examples of how you've effectively communicated with medical staff or facilitated discussions in previous roles.
Demonstrate Regulatory Knowledge: Mention your familiarity with CMS regulatory guidance and clinical documentation integrity. This will show that you understand the complexities of hospital billing and coding processes, which is crucial for the position.
How to prepare for a job interview at Sentara Health
✨Know Your Regulations
Familiarise yourself with CMS regulatory guidance and requirements related to Utilisation Review (UR) and hospital billing. Being able to discuss these regulations confidently will demonstrate your expertise and readiness for the role.
✨Showcase Your Interpersonal Skills
Since this role involves significant interaction with medical staff and hospital leadership, be prepared to showcase your superb interpersonal and communication skills. Share examples from your past experiences where you successfully collaborated with others.
✨Prepare for Case Discussions
Anticipate questions about how you would handle specific medical necessity reviews or denials management scenarios. Be ready to discuss your approach to peer-to-peer discussions and writing appeal letters, as these are key aspects of the job.
✨Demonstrate Flexibility and Teamwork
Highlight your ability to work collaboratively and adapt to changing situations. Provide examples of how you've worked effectively in a team environment, especially in high-pressure clinical settings.
