Physician Advisor

Job Description: Location: Guadalajara, Mexico Position: Full-Time Employee (FTE) Compensation: $25,840 Mexican pesos + competitive remuneration, annual performance-based bonus, and standard industry benefits Responsibilities: Provide healthcare services related to admissions, case management, discharge planning, and utilization review. Review admissions and service requests for prospective, concurrent, and retrospective medical necessity and/or compliance with reimbursement policies. Assist with coding, medical records/documentation, precertification, reimbursement, and claim denials/appeals. Notify attending physician and healthcare team of inappropriate admissions, denials, or reimbursement-impacting factors. Consult with attending physician to ensure completeness of clinical documentation. Act as liaison between Physician Advisor and attending physician. Document denial information in EMR system, including attempts at resolution/overturning denials. Provide payor communication for system documentation and appeals. Efficiently communicate with third-party payors, physicians, patients/families, physician practices, and other healthcare team members. Consult with medical staff regarding diagnosis, medical justification, treatment length, and case documentation. Participate in utilization and peer review meetings and projects. Competencies and Skills: Excellent written and spoken English High integrity and work ethics Self-starter with commitment to team excellence Client-focused mindset Attention to detail and concern for accuracy Strong time management and multitasking skills Team player with adherence to rules and regulations Academic and Professional Requirements: Doctorate in Medicine (MD)

Creado: Jue, 01 de Ene de 1970