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Physician Advisor Jobs

Company

Northeast Georgia Health System
Address , Remote
Employment type PART_TIME
Salary
Expires 2023-07-29
Posted at 11 months ago
Job Description
Job Category:
Executive Leadership, Physician Provider
Work Shift/Schedule:
10 Hr Afternoon - Evening
Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.
About the Role:
Job Summary
The Physician Advisor is a key member of the NGHS Revenue Cycle team and is charged with meeting the organization's goals and objectives for assuring effective, efficient, and compliant utilization of health care services. The role includes significant educational and supportive services, working with providers and hospital staff. The Physician Advisor shall develop expertise on matters regarding physician practice patterns, over and under utilization of resources, medical necessity, levels of care, care progression, denial management, compliance with governmental and private payor regulations, and documentation requirements. The role works closely with the entire medical staff, including resident physician house staff, all areas of resource management, Utilization Management and Case Management to develop and implement methods to optimize use of hospital services for all patients while also ensuring the quality of care provided. Concurrent communication with medical staff will be crucial to ensure timely documentation in the medical record, to include status orders that reflect the appropriate level of care.

Minimum Job Qualifications
  • Other:
  • Minimum Experience: Five (5) - seven (7) years physician practice experience, 10+ preferred. Possess or acquire solid foundation, knowledge an/or experience in areas of Utilization Management and Quality Improvement. Possess working knowledge of UR operations, along with standard UR metrics and payor methodologies. Experience and knowledge in healthcare Federal and State regulations is required. Strong computer skills and working knowledge of the EMR required.
  • Licensure or other certifications: Hold an unrestricted medical license in the state of Georgia. Member of the NGHS medical staff.
  • Educational Requirements: Medical Degree, Board certification required
Preferred Job Qualifications
  • Preferred Licensure or other certifications:
  • Other:
  • Preferred Experience:
  • Preferred Educational Requirements: Member of the American College of Physician Advisors (ACPA).
NGHS Core Competencies
  • Promoting Teamwork: Values the contributions of all; Connects others’ roles to organizational and team success; Encourages and supports; Cuts across boundaries to get things done; Puts own needs aside for good of the team and the organization
  • Being Accountable: Demonstrates tenacity and perseverance; Takes initiative; Engages resources to overcome obstacles; Has the courage to do the right thing even when difficult; Acts with integrity in accordance with our Core Values
  • Being Vulnerable: Admits mistakes and shortcomings; Shares thoughts and feelings openly; Is transparent without hidden agendas; Seen as authentic and genuine; Open and non-defensive to feedback
  • Listening: Practices attentive and active listening; Listens for the unsaid; Asks questions to confirm understanding; Hears people out without interrupting; Is open to viewpoints of others
  • Communicating Effectively: Shares information fully and offers knowledge and experience; Conveys ideas in a manner that engages others; Takes unpopular positions if necessary; Engages in unfiltered dialogue; Relates to others in a respectful manner, regardless of level, personality and background
  • Holding Others Accountable: Provides current actionable feedback, both corrective and reinforcing; Doesn’t allow problems to fester; Takes action when necessary, even if unpleasant; Uses every opportunity to give reinforcing feedback to others; Helps others see their blind spots
  • Displaying Empathy: Shares in the joys and pains of others; Is available and offers to help others; Shows concern for the challenges of others; Has a positive and kind demeanor; Takes a non-judgmental approach with others
  • Managing Disagreement: Acknowledges differing viewpoints and sees it as an opportunity to learn; Doesn’t run away from conflict; Strives for win/win solutions; Hammers out tough agreements; Finds common ground and solves problems for the good of all
  • Striving for Continuous Improvement: Experiments regularly with new ideas and approaches; Willing to fail; Learns from mistakes; Always seeks to be better tomorrow than today; Adapts to change
Organization Expectations
  • Regulatory Compliance: Ensures department’s compliance with all regulatory, DNV, mandatory education, and similar requirements.
  • Quest: Demonstrates/utilizes Quest tools in department.
  • Safety: Promotes patient, visitor and staff safety and effectively manages hazards that lead to injury or harm.
  • Talent Development: Coaches and develops staff.
  • Productivity: Meets productivity expectations.
Key Performance Indicators (KPI)
Identifies unit/department level goals that align with the organization's Key Performance Indicators.
HIPAA (Health Information Portability and Accountability Act)
If, in the normal course of my duties and responsibilities, I am required to access protected health information (PHI) and electronic protected health information (EPHI) for the purposes of treatment, payment and operations within Northeast Georgia Health System, I will limit such access to only the minimum necessary amount of PHI and EPHI necessary to perform the functions of my job. If access is not required in the normal course of my duties and responsibilities, I will not access PHI or EPHI.
Job Specific and Unique Knowledge, Skills and Abilities
  • Working knowledge of the Revenue Cycle processes and goals.
  • Working knowledge of criteria for Medicare, Medicaid, HMO and private insurance coverage; knowledgeable of Federal and State regulations and hospital finance.
  • Obtains familiarity and working knowledge of standard published criteria such as InterQual/MCG and applies professional judgement and patient specific variables as may be necessary of justifiable.
  • Functions with little direct supervision in accordance with the goals set forth by Administrators and Department Directors.
  • Demonstrates ability to drive results and produce outcomes.
  • Ability to work collaboratively; ability to network and access resources as needed by team.
  • Excellent customer service and interpersonal skills. Able to effectively present information, both formal and informal. Strong written and verbal communication skills with all levels of internal and external customers.
  • Persuasiveness and leadership to obtain action, consent, agreement, or approval. May involve difficult negotiations or a high degree of diplomacy and judgement to achieve results.
  • Requires an innovative, creative thinker to initiate long range programs, goals, policies and procedures. Ability to foresee and assess potential problems and to plan alternative solutions. Strong analytical skills.
  • Strong organizational skills and ability to set priorities and multi-task, demonstrates flexibility, teamwork, and is accustomed to change in the healthcare environment.

Essential Tasks and Responsibilities
  • Supports the Utilization Review process through second level reviews as needed and in a timely fashion. These include, but are not limited to: status reviews, condition code 44 second level reviews, compliance short stay reviews, surgery precert compliance, compliance with inpatient only procedures, continued stay reviews, HINN issuance. Assists in 2 midnight rule compliance. Works collaboratively with physicians and advanced health practitioners based on results of these reviews, to include gathering additional information, coaching to facilitate documentation that supports the level of care and timely discharge as indicated.
  • Assists in governmental regulation compliance through research, reviews, and education. Serves as active member of Acute/Post Acute Compliance Committee.
  • Assist with length of stay management and utilization of resources
  • Participation and active role in the Utilization Review Committee to include review of data related to utilization and presentation of findings with recommendations for improvement.
  • Identifies documentation opportunities through clinical/medical necessity reviews along with denial/appeal work. Drives documentation improvement strategies and works directly with providers to make improvements.
  • Participates in payor contract development and negotiation processes as requested. Provides input on utilization and precertification components based on experience with payors
  • Develops and maintains successful relationships within the payor community
  • Support physician education and collaboration, including but not limited to the following: Provide education to physicians and other clinicians related to regulatory requirements, appropriate utilization of hospital services, community resources and alternative levels of care. Create action plans to address issues. Provide concurrent physician coaching and on-going education on appropriate documentation to support level of care and care standards. Provide regular feedback to physicians and all other stake holders regarding level of care, length of stay and potential quality issues. Facilitate, mentor, and educate other physicians regarding payer requirements. Contacts physicians in a timely manner to resolve delays and achieve positive outcomes. Demonstrates positive outcomes through interventions with attending or consulting physicians that impact status determination, delay care and affect LOS, or avoidable days. Participates in Medical Staff education on Healthcare Payment Models as needed, including value based purchasing, clinically integrated care, bundled payments. Identifies denial trends and works with the medical staff and administration to resolve the issue.
  • Active participant in Complex Case Review, providing input on length of stay and transition of care opportunities
  • Active participation in denials management processes to include peer to peer discussions, case review and appeal writing, physician education in denial occurances and prevention, metric tracking and presentation.
  • Performs other duties and tasks as assigned.
  • Provides consultation to UR nurses and CM staff regarding complex clinical issues impacting length of stay, medical necessity and discharge transition

Physical Demands
  • Pushing/Pulling: Occasionally 0-30%
  • Kneeling/Stooping/Bending: Occasionally 0-30%
  • Weight Carried: Up to 20 lbs, Occasionally 0-30% of time
  • Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding, Driving
  • Vision: Moderate, Occasionally 0-30% of time
  • Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time
  • Standing/Walking: Occasionally 0-30%
  • Intensity of Work: Occasionally 0-30%
Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals.

NGHS: Opportunities start here.
Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.