Job DescriptionRCS-Physician AdvisorActs as a liaison between IU Health Revenue Cycle Services, hospital administration, and clinical staff, aiding in the optimization of hospital services, resource utilization, and medical necessity reviews. Provides clinical expertise and support to the IUH Utilization Management team and their work related to authorizations, concurrent reviews and payor denials.
ResponsibilitiesConnect to Promise - Demonstrates a commitment to IU Health's mission, vision, and values by exhibiting behaviors and delivering results that align with the strategic direction of the organization. Ensure IU Health is working toward its vision of improving the health of all Hoosiers by providing the best care for each person as we practice our values of purpose, excellence, compassion and team.
Ethical Practice - Demonstrates the highest level of confidentiality standards in handling of customer relations, medical and prescription records and Health Insurance Portability and Accountability Act (HIPAA) compliance. Maintains confidentiality as appropriate, earns trust and respect of others, and exhibits behaviors that express the ethical practice of a healthcare organization. Mitigates unintended consequences through careful analysis and observation of business practices. Reports and responds immediately to unethical behavior or conflicts of interest.
Analysis - Thoroughly analyzes problems and opportunities, and their impact on the business. Takes into account all fact-based and stakeholder information in order to evaluate alternatives and make judgment-rich decisions. Probes symptoms to determine the underlying causes of problems and then integrates information from a variety of sources to arrive at optimal solutions.
Business Acumen - Exhibits working knowledge of the department and function and how it is structured. Structures work to align with the goals and operations of department and function.
Collaboration - Coordinates job activities with team members and leaders as required. Finds workable solutions that can be leveraged by other team members. Seeks out and shares best practices for performing job duties. Engages, guides and mentors other team members as needed.
Critical Thinking - Leverages curiosity and insights to explore rationale behind decision-making. Connects pieces of information from various sources to improve problem solving capabilities and recommendations. Actively distinguishes questions, problems, and conflict. Combines existing knowledge and on-the-job experiences to ensure best practices are being implemented in day-to-day work.
Independent Judgment - Exhibits sound professional judgment and diplomacy in handling unexpected problems and frequent interruptions that require immediate action or attention.
Candidate QualificationsCandidates for the position will be evaluated according to the following criteria and competencies:
- Medical degree and board certification in a recognized medical or surgical specialty required.
- Relevant experience preferred.
- Current licensure to practice medicine.
- Clinical experience in a hospital setting.
- Understanding of clinical utilization review and healthcare regulations.
- Knowledge of current medical coding and billing practices.
- Excellent communication and interpersonal skills.
- Strong leadership abilities and a collaborative approach to problem-solving.
- Requires along with knowledge in the areas of Medical Necessity, health care regulatory requirements, and an understanding of medical coding and billing.
