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Physician Advisor
Temple Health – Temple University Health System. Provide clinical expertise and guidance to the Clinical Analysis and Appeals team .
About the role
Key responsibilities & impact- Provide clinical expertise and guidance to the Clinical Analysis and Appeals team
- Act as physician advisor for medical necessity appeals and Pennsylvania Medical Assistance (PAMA) utilization reviews
- Serve as a physician resource for regulatory and revenue cycle denial and appeals processes
- Provide utilization review for all PAMA cases and all utilization management denials and appeals
Requirements
What you’ll need- Doctorate Degree in Medicine or Osteopathic Medicine required
- 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 as an expert witness, required
- General experience in a managed care environment required
- PA medical physician license or PA osteopathic physician license required
- Experience in an administrative leadership role preferred