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19102, Philadelphia, PA
PHYSICIAN ADVISOR (Per Diem) - Temple University Hospital

Sonic Summary

The position requires a Doctorate Degree in Medicine or Osteopathic Medicine and a Pennsylvania Medical Physician License or PA Osteopathic Physician License.
Candidates must have general experience and a strong working knowledge of the Interqual Criteria Set and hospital reimbursement systems.
Experience in dealing with second and third level appeals processes, including direct experience as an expert witness, is required.
General experience in a managed care environment is also necessary, while experience in an administrative leadership role is preferred.
The salary for this position is not specified, but it typically requires several years of relevant experience in clinical analysis and appeals.

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

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PHYSICIAN ADVISOR (Per Diem) - Temple University Hospital