Physician Advisor DRG & Appeals

Description Brundage Group provides revenue cycle solutions and physician advisory services that empower hospitals nationwide to capture earned revenue, ensure compliance, and improve operational efficiency. We blend clinical thought leadership with cutting-edge technology to help hospitals stay viable to continue serving our communities. We are hiring a physician advisor with expertise in denials management, CDI and coding. The Physician Advisor (PA) will focus on denials management and pre-bill DRG chart reviews. The PA is responsible for reviewing payor denials and authoring an appeal letter when an appeal is supported. The PA will support Medical Necessity denials, Clinical Validation denials and coding denials. The PA will work with the Brundage Group Clinical Coding Analysts and provide oversight to their work. The PA will also review pre-bill charts for documentation and coding accuracy. The PA should have strong clinical experience, denials management experience, CDI knowledge and coding knowledge to author compelling arguments based on clinical documentation in the health record, coding guidelines, and clinical validation standards. The PA will also interact with medical directors of third-party payers to discuss denials and perform P2Ps when necessary.

Requirements

Duties and Responsibilities: Denials Management Functions

• Perform peer to peers with payors
• Act as a liaison with payors to facilitate approvals and prevent denials or carved out days when appropriate
• Manages denial review work queues for assigned clients
• Performs chart reviews to evaluate the validity of payor denials to determine if an appeal is warranted
• Completes medical necessity, clinical validation and other DRG-related appeals
• Analyzes trends in denial topics, volumes and prevention strategies for clients as needed
• Collaborates with a Clinical Coding Analyst on co-authored coding appeals
• Participates in client calls to support the client relationship and company meetings as needed
• Works collaboratively with operations, client engagement and clinical account executives to ensure cases are received in a timely manner and processed accordingly to meet payor deadlines
• Provides input and recommendations to Brundage Group management for process improvement
• Maintain IT access to client sites
• Maintains HIPAA compliance
• Responsible for other duties as assigned or requested

Pre-bill Chart Review Responsibilities

• Collaborate with a clinical coding analyst to review charts for documentation and coding accuracy
• Identify denial prevention and missed revenue opportunities and provide education to clients as needed
• Provide clinical expertise and educational support as needed to clinical coding analysts
• Participate in client education sessions for providers, CDIs and coders, as requested
• Identify documentation and coding trends to help improve client processes

KNOWLEDGE, SKILLS, AND ABILITIES: Abilities may be accessed through written, verbal, and other evaluation methods.

• Strong knowledge of inpatient coding and Official Coding Guidelines
• Strong knowledge of clinical validation criteria for commonly denied diagnoses
• Experience working with coders and CDI specialists
• Strong interpersonal skills
• Excellent written and verbal communication skills
• Strong computer skills and working knowledge of EMRs
• Ability to work independently
• Ability to build relationships with key hospital team members

WORK EXPERIENCE, EDUCATION AND CERTIFICATIONS: List preferred/required work experience, education, and certifications.

• MD or DO
• Current, unrestricted medical license in state of residence
• Demonstrated ability to build rapport with medical staff and hospital leadership
• Prior Physician Advisor experience authoring appeal letters
• Preferred Qualifications:
• Board Certified / Eligible
• CCDS or CDIP
• CCS
• CHCQM certification (ABQAURP)

Working Conditions And Physical Requirements Conditions typically associated with an office environment. While performing the essential duties and responsibilities, the employee is regularly required to talk or hear. May be frequently required to sit, stand or walk. Moderate to prolonged reading, typing, and computer work. Ability to perform tasks involving physical activity that may include lifting 25 pounds. Subject to exposure to all environmental hazards associated with healthcare and office work. Apply tot his job Apply To this Job