Medical Necessity Specialist - Pittsburgh - beBeePhysicianAdvisor

    beBeePhysicianAdvisor
    beBeePhysicianAdvisor Pittsburgh

    3 days ago

    Job title: Onsite Physician Advisor

    Description

    Job Summary

    The onsite physician advisor role requires expertise in medical necessity, documentation best practices, and concurrent denial payor peer-to-peer interactions.

    Main Responsibilities:

    • Conduct second-level reviews for all payor types to determine compliance status.
    • Maintain effective communication with case management, utilization management, social work, and other healthcare team members to discuss selected cases and make recommendations.
    • Engage with medical staff to discuss medical necessity and concurrent denial cases.
    • Act as a consultant for the medical staff regarding their decisions for patient status through case reviews.
    • Participate in the claims denial process by conducting discussions with commercial payor medical directors.
    • Serve on the Utilization Review Committee, requiring non-clinical medical staff privileges application.

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