PHYSICIAN ADVISOR

Education:

• Minimum Level of Education Required: Medical Doctorate degree

Additional requirements:

• Type of degree: MD or DO
•  Area of study or major: Medicine
•  Preferred educational qualifications: N/A
• Position-specific testing requirement: CHCQM Phy Adv board certification or ACPA-C Certification

Licensure/Certification/Registration

• Physician licensed to practice in the state of Ohio

• CHCQM Physician Advisor certification

• ACPA-C certification

• CCDS certification

• Board Certification in some specialty – current or expired

Experience:

• Minimum Level of Experience Required: 2-3 years of experience in UR/Denials/CDI/Coding

• Prior job title or occupational experience: Minimum of 5 years of experience in clinical practice
• Prior specific functional responsibilities: Prior experience in Utilization Management, Denials, CDI, Coding
• Preferred experience: Prior experience in Utilization Management, Denials, CDI, Coding
• Other experience requirements: Leadership in practice, programs, and projects

Knowledge/Skills

• Utilization Management & Utilization Review

• Payer practices & CMS regulations

• Clinical Documentation Integrity & Coding
•  Patient levels of care

•  Continuum of Care management

• Post Acute transition

• Process Improvement Skills (Lean Six Sigma)