Regional Physician Advisor Position (Southeast) Coastal Virginia Near the Beach

City / State

Norfolk, VA

Work Shift

First (Days)

Overview :

The Regional Physician Advisor supports the Clinical Revenue Cycle's Utilization Review and Denials / Appeals processes to determine and secure appropriate level of care assignments to ensure compliant billing, assist with denials management, support documentation integrity as it pertains to accurate coding capture. The Regional Physician Advisor interfaces with hospital and medical staff leadership, facilitating communication between Revenue Cycle leadership and processes and the hospital facilities and championing processes and initiatives. The Regional Physician Advisor assists with both formal and informal education of medical staff at Sentara hospital facilities. This role is responsible for supporting and meeting the Clinical Revenue Cycle functions organizational goals and objectives for assuring the effective, efficient utilization of health care services.

Due to regulatory requirements, this role requires an active and unrestricted Virginia medical license, thorough understanding of the Medicare regulatory requirements as they relate to hospital UR activities and medical necessity criteria / tools, high level of proficiency working within Epic (EMR), and a working knowledge of clinical documentation integrity and hospital coding / billing practices. The nature of this role is collaborative and highly relational, and therefore requires significant on-site (in person) presence to facilitate development of relationships, communication and education. Superlative interpersonal and communication skills as well as superb analytical skills are integral to the success of the role. Coverage at additional sites may be required, including occasional in-person responsibilities at sites within a 25 mile radius of assigned primary sites. The position reports to the Director of Regional Physician Advisors.

Principal Duties and Responsibilities :

• Perform timely and compliant third level medical necessity site of service / status reviews, providing clear documentation of the pertinent details of the case to satisfy regulatory requirements
• Facilitate denials management through review of selected cases, conducting peer to peer discussion with third party payers as appropriate, and assisting with appeals letters as appropriate
• Work closely with hospital leadership, medical staff, and hospital ICM leaders to support system CPIs and initiatives
• Actively participate in Hospital UM committees at designated sites
• Supervise Physician Advisor staff
• Recruit and mentor Physician Advisors
• Participate in training and continuing education for the Physician Advisor program
• Present educational topics to medical staff, administration, leadership and peers
• Complete evaluations of staff Physician Advisor work product
• Attend continuing education pertaining to utilization and quality management
• Additional functions as deemed appropriate and warranted

Minimum Requirements :

Benefits : Caring For Your Family and Your Career

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission "to improve health every day," this is a tobacco-free environment.

For positions that are available as remote work, Sentara Health employs associates in the following states :

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.