Physician Advisor
- Req ID: req5576
- City, State: New Brunswick, NJ
- Department: Physician Advisors
- Job Type: Hybrid
- Job Schedule: Part-Time
Physician Advisor
Physician Advisors
The Physician Advisor will:
• Provide timely reviews and medical decision-making ensuring patients are in the appropriate level of care in compliance with governmental regulations, conditions of participation and commercial insurance contracts.
• Assist with the denial management/appeal process by engaging in insurance payer Peer-to-Peer discussions, and retrospective payer admission/DRG denials.
• Provide advice regarding resource management, including whether certain tests, procedures, or consultations could be safely and appropriately deferred to the outpatient setting.
• Provide feedback to attending and consulting physicians regarding level of care, length of stay, and throughput issues. Seeks additional clinical information from the attending and consulting physicians. Recommend and requests additional, more complete, medical record documentation.
• As needed, participates in the Utilization Review Committee.
• Provide clinical advice relative to coding inquiries for Clinical Documentation Integrity (CDI) staff. Assists in clarifying documentation in the medical record. Provides physician-to-physician contact for coding or clinical documentation issues.
• Provide guidance and expertise, when requested, in the evaluation of payer contracts.
Requirements:
• A Medical degree and the successful completion of ACGME or AOA residency
• MD or DO license in the State of New Jersey
• Board certification or eligibility from the appropriate specialty or subspecialty board
• CDS and DEA license required
• Must qualify for Saint Peter's University Hospital Liability insurance
Full-time clinical base compensation at Saint Peter's Healthcare System ranges from 125,000.00 - 750,000.00 USD, which is impacted by various factors, including but not limited to physician specialty, level of experience, quality of care, academic accomplishments, patient experience and productivity. The base compensation range listed is a good faith determination of potential base compensation at the time of this job advertisement and may be modified in the future.
Physician Advisors
The Physician Advisor will:
• Provide timely reviews and medical decision-making ensuring patients are in the appropriate level of care in compliance with governmental regulations, conditions of participation and commercial insurance contracts.
• Assist with the denial management/appeal process by engaging in insurance payer Peer-to-Peer discussions, and retrospective payer admission/DRG denials.
• Provide advice regarding resource management, including whether certain tests, procedures, or consultations could be safely and appropriately deferred to the outpatient setting.
• Provide feedback to attending and consulting physicians regarding level of care, length of stay, and throughput issues. Seeks additional clinical information from the attending and consulting physicians. Recommend and requests additional, more complete, medical record documentation.
• As needed, participates in the Utilization Review Committee.
• Provide clinical advice relative to coding inquiries for Clinical Documentation Integrity (CDI) staff. Assists in clarifying documentation in the medical record. Provides physician-to-physician contact for coding or clinical documentation issues.
• Provide guidance and expertise, when requested, in the evaluation of payer contracts.
Requirements:
• A Medical degree and the successful completion of ACGME or AOA residency
• MD or DO license in the State of New Jersey
• Board certification or eligibility from the appropriate specialty or subspecialty board
• CDS and DEA license required
• Must qualify for Saint Peter's University Hospital Liability insurance
Full-time clinical base compensation at Saint Peter's Healthcare System ranges from 125,000.00 - 750,000.00 USD, which is impacted by various factors, including but not limited to physician specialty, level of experience, quality of care, academic accomplishments, patient experience and productivity. The base compensation range listed is a good faith determination of potential base compensation at the time of this job advertisement and may be modified in the future.
