Providing clinical expertise and guidance, the full-time Pennsylvania Licensed Physician Advisor will support the Clinical Analysis and appeals team by managing medical necessity appeals and PAMA utilization reviews in a remote capacity. Key responsibilities Act as the physician advisor for medical necessity appeals and PAMA utilization reviews Serve as a resource for regulatory and revenue cycle denial and appeals processes related to hospital activities Utilize strong knowledge of the Interqual Criteria Set and hospital reimbursement systems to guide clinical decisions Required qualifications Doctorate Degree in Medicine or Osteopathic Medicine PA Medical Physician License or PA Osteopathic Physician License Strong working knowledge of the Interqual Criteria Set and hospital reimbursement systems Experience with Second and Third level appeals processes, including expert witness experience Experience in a managed care environment
Pennsylvania Licensed Physician Advisor in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.