Physician Advisor

The client is looking at hiring a Physician Advisor for their team at Guadalajara, Mexico. Education : Doctorate in Medicine. RESPONSIBILITIES: Acting as a consultant for other physicians and providers, not only for resource utilization, but for best billing practices, medical record and documentation concerns, medical necessity, and other concerns that could cause complications for physicians and the organization. Engaging in discussions with insurance companies and medical directors for cases where payment or prior authorizations have been denied. Conducting second-level case reviews for medical necessity and assessing cases for appropriateness for hospital services or certain levels of stay. Assisting case management with length of stay reviews and advising attending physicians for difficult cases with non-standard plans of care situations. Providing recommendations on inpatient admissions and outpatient services. Intervening in difficult situations between patients and clinicians or patients and the hospital system. Reviewing national guidelines or standard of care to help guide policies within the hospital system. Reviewing SLR (second level review) cases for UR (Utilization review) nurses. COMPETENCIES, SKILLS AND OTHERREQUISITES : Unflinching integrity and personal work ethics Self-starter who strives for self and team excellence Flair for client satisfaction Attention to detail and concern for accuracy Excellent time management skills and multi-tasking ability Excellent team player Compliant to rules and regulations Have strong communication skills. Are people persons – not just with fellow physicians, but hospital admin, other service providers, insurance company directors, and more. Have an up-to-date understanding of regulation compliance and are willing to stay up to date with inpatient medicine guidelines and regulatory requirements. Have good investigative and research skills and can be objective. Able to work efficiently and navigate complex medical charts to extract relevant information.

Creado: Jue, 01 de Ene de 1970