Physician Advisor (Ft; 40Hrs/Wk) - Temple University Hospital

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 '405430