AdventHealth Denials Management Physician Advisor in Altamonte Springs, Florida
Denials Management Physician Advisor AdventHealth Corporate
Location Address: 900 Hope Way Altamonte Springs, Florida 32714
Top Reasons To Work At AdventHealth Corporate
Immediate Health Insurance Coverage
Career growth and advancement potential
- Full-Time, Monday – Friday
You Will Be Responsible For:
Responsible for writing and submitting appeals (multiple levels as needed) specifically around medical necessity, non-covered services, experimental care, authorizations, and inpatient/observation stay related denials.
Researches medical record, patient history and chart, payer contracts & policies to accurately represent patient care provided using medical & clinical justification in the appeal letter.
Analyzes denials data and trends to works with Managed Care contracting team and patient financial services to identify opportunities to address retrospective denials through the contracting process.
Reviews payer denials and intervenes with attending and/or consulting physicians and managed care medical directors, as needed, for reconsideration and denial avoidance. Makes determinations for appeals & grievances from team members.
Responsible for providing physician review of utilization, claims management, and quality assurance related to inpatient care, outpatient care/observation stays and referral services.
What You Will Need:
Graduate from medical school and residency program
Ten years recent clinical practice experience
Seven years of leadership experience
Current, valid state license as a physician
Board certified and eligible for membership on the Hospital medical staff
The Physician Advisor is responsible for writing and submitting clinical denial appeals, performing concurrent reviews and peer-to-peer discussions with payer representatives and educating clinical staff on process improvement opportunities to increase reimbursements and reduce clinical denials. This role utilizes clinical knowledge & experience, information science, and interpersonal skills to support and represent the optimal denials recovery and prevention processes identified with all medical, clinical and ancillary departments. This role researches and responds to denials in a timely fashion and identifies trends and responds to the trends by recommending changes in practice and/or documentation of the providers to promote a reduction in the denials trends. This role acts as a bridge between providers and other staff to improve clinical documentation, utilization review, and claim denials management. This position also serves as subject matter expert, providing clinical expertise and business direction in support of medical management programs, promoting the delivery of high quality, patient focused and cost effective medical care. Adheres to AHS Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies.
This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.
We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.