Position Details
This is Full-Time Benefit Eligible position working 80 hours per biweekly pay period.Location: 1324 Lakeland Hills Blvd Lakeland, FL - Onsite
Annual Salary: Min $161,200.00 Mid $215,300.80
Position Summary
The Physician Advisor serves as a liaison between the clinical document improvement (CDI) team, which includes hospital coders; members of the Hospital's administration; the Medical Staff of the hospital; and the hospital's Utilization Management to facilitate the development and implementation of clinical documentation improvement initiatives. The Physician Advisor is pivotal in leveraging his or her clinical position to demonstrate the association of care delivery with specificity in documentation. The Physician Advisor is responsible for conducting clinical reviews referred by the Utilization Management, Coding and Clinical Documentation Improvement departments. The Physician Advisor will assist with reviews and appeals of DRG and medical necessity denials.
Position Responsibilities
Standard Work: Physician Advisor - Acts as a liaison between the CDI professionals, Health Information Management, and the hospital's medical staff to facilitate accurate and complete documentation for coding and abstracting of clinical data, capture of severity, acuity and risk of mortality, HCC/risk adjustment in addition to Diagnosis Related Group (DRG) assignment.
- Perform concurrent and retrospective reviews of selected health records as it pertains to CDI and coding validation, and participate in the development of clinically appropriate and compliant provider queries to further clarify documentation.
- Educates individual hospital staff physicians about International Classification of Diseases (ICD) coding guidelines and clinical terminology to improve their understanding of severity, acuity, risk of mortality, HCC/risk adjustment and DRG assignments on their individual patient records.
- Assists with the evaluation and appeal of concurrent and retrospective denials and retrospective DRG downgrades. May perform peer-to-peer meetings as required.
- Participates in the coding and CDI programs and identifies potential areas for improved documentation of services. Also participates in the Coding and CDI meetings and provides ongoing education to the team members.
- Provides peer to peer communication to affect the appropriate response for those cases where the physician fails to respond or questions the need for queries.
- Responsible for writing and submitting appeals (multiple levels as needed) specifically around medical necessity, non-covered services, authorizations, and inpatient/observation stay related denials. May perform peer-to-peer meetings as required.
- The Physician Advisor is pivotal in leveraging his or her clinical position to demonstrate the association of care delivery with specificity in documentation through effective communication and education of the respective parties.
- Provides his or her expert opinion in relation to clinical validity assessments, and, furthermore, the development of clinically robust and appropriate queries.
- Serves as second level reviewer for UM, providing guidance on appropriate/alternate levels of care based on InterQual guidelines and other appropriate criteria.
Competencies & Skills
Essential:
- Broad knowledge base of clinical medicine across all specialties.
- Basic coding guidelines regarding the selection of the principal diagnosis and reporting additional diagnoses and procedures; understanding the DRG system; levels of comorbidities; and concepts of risk adjustment, severity of illness, risk of mortality, case mix index, prospective payment, hospital acquired conditions, patient safety indicators.
- Organize tasks effectively and efficiently and the ability to act independently through the application of critical thinking skills.
- Computer skills appropriate to position
- Excellent written and verbal communication skills.
Qualifications & Experience
Essential: Medical Degree
Essential: Licensed to practice medicine in the state of Florida, shall be board certified in internal medicine, and shall meet any other reasonable professional criteria established by LRH or the hospital.
Experience Essential:
- Minimum of two years of experience in conducting coding and CDI reviews.
- Knowledge of coding guidelines and how it translates from clinical documentation.
- Knowledge of DRGs, Risk of Mortality, Severity of Illness, Mortality Rate, HCC/risk adjustment, CMI and the impact of clinical documentation/coding in relation to these metrics.
- Excellent computer skills with prior exposure to use of Microsoft Office suite
