HCA Healthcare – Physician Denial Advisor WFH – Denver, CO

Company: HCA Healthcare

Industry: Private

Employment Type:- Full Time

Work Hours:-  8 Hours

Locations:- USA

Full Job Description:-

HealthONE, as part of the HCA Healthcare Continental Division, was named the #1 large hospital system in the United States by IBM Watson Health as part of the 15 Top Health Systems recognition process. HealthONE is the largest healthcare system in the metro Denver area with more than 11,000 employees. As part of the HealthONE system of care, The Medical Center of Aurora, Centennial Hospital, North Suburban Medical Center, Presbyterian/St. Luke’s Medical Center, Rocky Mountain Hospital for Children, Rose Medical Center, Sky Ridge Medical Center, Swedish Medical Center, and Spalding Rehabilitation Hospital work together to provide a higher level of care. In addition, our family of services includes several hospital free-standing emergency departments and numerous ambulatory surgery centers, CareNow urgent care and occupational medicine clinics, physician practices, imaging centers, and AIRLIFE-DENVER, which provides critical care air and ground transportation across a 10-state region. And, as the #7 corporate philanthropist in the Denver-metro area, and the only hospital system in the top 10, HealthONE contributed more than $1.6 million in 2019 and supports over 150 organizations through cash and in-kind donations.

GENERAL SUMMARY OF DUTIES: The PDA is responsible for conducting Peer to Peers on cases where the attending Physician cannot. The PDA is also responsible for identifying Physician documentation trends that result in denials as well as help with improving documentation as it relates to CDI. The PDA will provide one on one Physician education on improving documentation that can reduce denials. The PDA works with the Division Vice President of Revenue Management to reduce denials and subsequent Peer to Peers. The PDA will attend various Medical Staff meetings to update the staff on recent payer trends as well as Division P2P strategies.

SUPERVISOR: VP of Revenue Management

SUPERVISES: N/A

DUTIES INCLUDE BUT ARE NOT LIMITED TO:

  • Conducts Peer to Peers on cases when the attending physician cannot.
  • Provides clinical support and guidance in the development and deployment of all denial reduction initiatives.
  • Utilizes data analytic tools to educate physicians on utilization improvement.
  • Provides one on one Physician education on improving documentation that can reduce denials.
  • Serves as a spokesperson to medical staff and physicians to explain the payer denial trends as well as strategies to reduce denials.
  • Provides input to facility-level physicians on CDI documentation to reduce issues.
  • Provides leadership and medical consultation on managed care issues including providing clinical support for appeals and denials process.
  • Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement.”

KNOWLEDGE, SKILLS & ABILITIES:

Other Jobs You May Be Interested In

  • Knowledge of the Health Care Environment – The understanding of the healthcare system and the environment in which healthcare managers and providers function.
  • Possesses and uses current knowledge of quality improvement and assurance, staff and meeting organization, and approaches to the delivery of medical care and strategies for examining and applying relevant concepts.
  • Has knowledge of all HCA and HealthONE clinical technologies and assists with the education of physicians on these systems. This knowledge may be gained on the job.
  • Familiarity and comfort with electronic medical records, computerized physician order entry systems and clinical data analytic tools.
  • Ability to understand computer and information systems technical information sufficient to use the tools, to effectively explain the tools to physicians and to engage them in successful adaption of new information systems clinical tools.
  • Has a demonstrated understanding of the social, political, and economic influences affecting health care program and services.
  • Demonstrated ability to advise the leaders of the hospital, medical staff, and clinical staff in the facilities’ decision-making structures and processes.
  • Demonstrated ability to advise the medical staff, the nursing staff, and other clinical team members in developing hospital quality-assurance plans and implements ongoing programs to measure, assess, and improve the quality and outcomes of patient care.
  • Demonstrated ability to advise the facility medical staff and administration team, in compliance with and in preparation for reviews by the state, federal, JCAHO, and other regulatory agencies.
  • Demonstrated ability to apply business principles, including systems thinking, to the healthcare environment.
  • Demonstrated ability to inspire individual and organizational excellence, create a shared vision and successfully manage change to attain the facility’s strategic end and successful performance.
  • Demonstrated ability to communicate effectively, both verbally and in writing; to organize and to plan, facilitate, and mediate with physicians as individuals or groups; and to anticipate problems and work effectively to resolve them.
  • Demonstrated ability to align personal and organizational conduct with ethical and professional standards that include a responsibility to the patient and community, a service orientation, and a commitment to lifelong learning and improvement.

We offer you an excellent total compensation package, including competitive salary, excellent benefit package and growth opportunities. We believe in our team and your ability to do excellent work with us. Your benefits include 401k, PTO medical, dental, flex spending, life, disability, tuition reimbursement, employee discount program, employee stock purchase program and student loan repayment. We would love to talk to you about this fantastic opportunity.

Qualifications

EDUCATION/LICENSURE/CERTIFICATION

  • Licensed (or eligible for licensure) in the State of Colorado as an M.D. or D.O.
  • Will apply for and obtain Colorado license within six months of hire
  • Board Certification in a clinical discipline required
  • An MBA or equivalent preferred or additional education and coursework in management and business required

EXPERIENCE

  • Minimum 5 years of clinical practice preferred
  • Must possess all of the qualifications for Medical Staff membership
  • Must be eligible for medical staff membership to provide patient care services.
  • PREFERED experience in implementation of CPOE and EMR (e.g., Horizon Patient Folder products).

HCA Healthcare – Physician Denial Advisor WFH – Denver, CO

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