JOB SUMMARY: The Physician Advisor is a key member of the hospital’s leadership team and is charged with meeting the hospital’s goals and objectives for assuring the effective, efficient utilization of health care services and accurate, complete documentation. The Physician Advisor serves as a clinical resource, educator and consultant to physicians, advanced practice providers, hospital administration, Clinical Documentation Improvement (CDI)/Utilization Review (UR) staff, and third party payers as it relates to documentation of level of care and the accurate reflection of acuity and severity of illness for admissions to the hospital. The Physician Advisor helps to create and cultivate a culture of documentation integrity and awareness among physicians and develops a streamlined communication channel between leadership, administration and the medical staff and improves collaboration between physicians and the UR and CDI staff. Acts as liaison with payers to facilitate approvals and prevent denials of carved out days when appropriate by participating in Peer to Peer discussions and reviews. The Physician Advisor shall develop expertise on matters regarding physician practice patterns, medical necessity, level of care, care progression, denial management, compliance with government and private payer regulations, and appropriate physician coding and documentation requirements.
EDUCATION and/or EXPERIENCE:
- Minimum of 5 years recent experience in clinical practice, inpatient experience is preferred.
- Graduate of an accredited medical school. Additional education in utilization management and clinical documentation through continuing medical education programs and self-study.
- Experience in utilization review, coding (ICD 10 PCS/CM, DRG and CPT), clinical documentation improvement, or leadership experience strongly preferred.
- Physician Advisor experience preferred.
- Maintain current knowledge of federal, state, and payer regulatory and contract requirements
CERTIFICATION, LICENSURE, and/or REGISTRATIONS:
- South Dakota Medical License required within 90 days of employment.
- Certified Clinical Documentation Specialist (CCDS) from the Association of Clinical Documentation Improvement Specialists (ACDIS) OR
- Certified Coding accreditation from AHIMA (American Health Information Management Association) in one of the following: Certified Documentation Improvement Practitioner (CDIP), Certified Coding Associate (CCA) or Certified Coding Specialist (CCS) is required within 3 years of hire.
- May seek American Board of Quality Assurance and Utilization Review Physicians Health Care Quality Management and Board Certification (ABQAURP HCQM) as a Physician Advisor.
- Maintain membership in the American College of Physician Advisors
- Maintain membership in ACDIS, AHIMA and ACMA.