Physician Advisor Coordinator (Remote)

Job Description

Community Health Systems is one of the nation’s leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.

Summary

The Physician Advisor Coordinator will execute coordination of Physician Advisors peer to peer work efforts with external health plans by assigning and scheduling cases that require review. This individual will work with Case management/ Utilization review teams to serve as traffic control for case assignments, tracking, and documentation of outcomes or determinations. Daily interaction among leadership, external payers, auditors and the Shared Service Center (SSC) to facilitate communication and actions related to the denial management processes.

Supervisor: Manager, Physician Advisor Coordinator

Essential Duties and Responsibilities (include, but are not limited to):

• Responsible for assigning, setting up and managing Peer to Peer (P2P) reviews for Physician Advisors (PA)
• Work with Utilization Review teams and PA’s on denial and P2P strategies
• Manages multiple calendars- sending/receiving appointment invites through online calendar system.
• Maintain knowledge of commercial payer denial, authorization strategies/ practices, and contractual agreements
• Possess current knowledge of CMS, Corporate and Regional UR requirements and billing procedures
• Monitor P2P’s and observation (OBS) vs inpatient (IP) cases
• Monitor status review determinations
• Monitor and update pertinent information in UR or Shared Services platforms
• Maintain P2P impact report for the Physician Advisors
• Participates in joining meetings with Revenue management, Shared Services, and Utilization Review
• Practice and adheres to the corporate culture, “Code of Conduct” and “Mission and Value Statements.”
• Other duties as required
  
  

Knowledge, Skills, And Abilities

• Exceptional written and verbal communications skills
• Proficient in computer applications such as Microsoft Office, Google Suite, data bases & internet queries
• Proficiency in typing and 10 key skills
• Conducts all activities with personal integrity, dignity, respect and civility
• Independent and self-motivated with time management expertise
• Maintains long-term customer relationships, building trust and respect; consistently exceeding expectations
• Works effectively with physicians, employees, associates and external parties
• Proficient using all health plan “Payer” portals
  
  

Qualifications

• Required education - High school graduate Preferred education - College degree
• Experience - Minimum of 2–3 years of UR Coordinator, SSC and/or Patient Registration experience preferred
• Certificate/license - None required
  
  

Physical Demands And Working Conditions

• Requires prolonged sitting, bending, stooping and stretching.
• Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, and other office equipment.
• Requires normal range of hearing and eyesight to record, prepare and communicate appropriately.
• Requires lifting up to 20 pounds occasionally.
• Work is performed in an office environment with timely performance expectations and occasionally includes challenging circumstances, which require exceptional diplomacy skills.