Position SummaryThe Nurse Practitioner (NP) Physician Advisor serves as a clinical advisory expert embedded within J2's middle revenue cycle consulting practice. This role bridges clinical documentation and revenue integrity by providing advanced clinical knowledge to support CDI programs, utilization management, medical necessity review, denial management, and provider education. The NP Physician Advisor functions as a trusted partner to health system clients, translating complex clinical scenarios into actionable, compliant documentation and revenue cycle outcomes. This is a people-first, outcomes-driven role for a clinician who is equally comfortable in patient care data and payer policy.
Key Responsibilities- Clinical Documentation Integrity (CDI) Support: Conduct clinical reviews of inpatient and outpatient medical records to identify documentation gaps, clarify diagnoses, and support accurate DRG assignment. Collaborate with CDI specialists and physicians to ensure documentation reflects the full complexity and severity of patient conditions.
- Medical Necessity Review and Utilization Management: Perform clinical reviews to assess appropriateness of level of care, admission status, and continued stay criteria in alignment with payer requirements, InterQual/MCG criteria, and CMS guidelines.
- Denial Prevention and Clinical Appeals: Partner with Revenue Integrity and Coding teams to review and respond to clinical denials, prepare evidence-based clinical appeal letters, and provide root cause analysis to reduce recurrence.
- Provider Education and Engagement: Design and deliver targeted provider education on documentation best practices, CDI query processes, and regulatory requirements, building trusted relationships that promote sustainable documentation improvement.
- CDI Query Management and Optimization: Develop, review, and refine clinical documentation queries in alignment with AHIMA and ACDIS query practice standards, monitoring query response rates and outcomes to improve quality, timeliness, and clinical specificity.
- Clinical Advisory Consulting: Serve as a subject matter expert on clinical topics including sepsis, respiratory failure, malnutrition, chronic disease complexity, and surgical complications, guiding client teams and project leadership on clinically complex cases.
- Payer Policy and Regulatory Compliance: Stay current on CMS coverage policies, LCD/NCD updates, payer-specific clinical criteria, and applicable coding guidelines (ICD-10-CM/PCS, CPT) to advise clients on compliant documentation and billing practices.
- Client Engagement and Reporting: Participate in client-facing meetings and workgroups as a clinical voice, communicating findings and recommendations in a clear, executive-appropriate format for CFOs, CMOs, and HIM leadership.
- Quality Metrics Monitoring and Improvement: Track and analyze KPIs including query rates, response rates, CC/MCC capture rates, denial rates, and case mix index (CMI) trends to drive continuous improvement and demonstrate measurable value.
- Collaborative Teaming and Knowledge Sharing: Function as an integrated member of J2's clinical and consulting teams, contributing to internal knowledge-sharing and peer mentoring while modeling J2's Excellence standards in every engagement.
Qualifications & Experience- Certification: Active, unrestricted Nurse Practitioner license required. CDIP (Certified Documentation Integrity Practitioner) or CCDS (Certified Clinical Documentation Specialist) credential preferred.
- Education: MSN, DNP, or equivalent advanced practice nursing degree.
- Experience: Minimum 3-5 years of clinical practice (acute care, hospitalist, or critical care preferred), with demonstrated experience in CDI, utilization management, or revenue cycle advisory. Background in denial management, clinical appeals, or utilization review nursing preferred.
- Technical Proficiency: Familiarity with payer criteria tools (InterQual, MCG/Milliman, Optum ClinicalAdvisor) and major EHR platforms (Epic, Cerner) in a revenue cycle context.
- Industry Knowledge: Strong working knowledge of ICD-10-CM/PCS coding, DRG methodology, CMS coverage policies, LCD/NCD guidance, and clinical documentation requirements.
- Skills: Advanced clinical judgment; revenue cycle fluency; excellent written and verbal executive communication; integrity and accountability; and collaborative leadership that elevates the people and teams around them.
