This Physician Advisor Liaison’s primary function is to provide clerical and operational support for the SLUHN Physician Utilization Management Program. The physician advisor liaison will provide administrative assistance to the Medical Director and to the Physician Advisors in the program.
JOB DUTIES AND RESPONSIBILITIES:
1. In a time sensitive manner, gathers pertinent medical records data relating to medical cases that are being appealed, by accessing various EMR systems and paper records and logs.
2. Working with in-patient staff and physicians as well as other Hospital departments (Quality, Risk, Case Management, Coding, Finance, Denials Management, etc.), interprets and abstracts data from medical records and organizes data in format for appeal submission.
3. Reviews appeal submissions and makes any necessary edits prior to submission.
4. Communicates with the Denials Department on any past or current appeals that need to be performed at the ALJ level and schedules those hearings accordingly; tracks outcomes.
5. Develops and maintains log on appeal dates, decisions and follow up dates. Ensures that appeals are submitted on time and completes follow up on submissions.
6. Maintains statistics related to individual and department cases tasked per pay period, including Kronos administration.
7. Completes data abstraction and entry related to the physician advisor program outcomes.
8. Coordinates all Medical Assistance phone calls between the Medical Director or designee and the Department of Public Welfare Medical Director; tracks outcomes.
9. Coordinates all peer-to-peer calls between the Medical Director or designee and the insurance company Medical Directors related to concurrent denial activity; tracks outcomes.
10. Develops and maintains physician advisor services scorecard.
11. Provides general administrative support to the Medical Director, insuring organization and efficiency in the daily routine.
12. Attends department meetings, records attendance and meeting minutes, types and distributes to staff and administration as assigned.
13. Develops and maintains a yearly schedule for the Medical Director for ongoing education sessions with various medical and ancillary departments as designated.
14. Maintains confidentiality of all materials handled within the Network/Entity as well as the proper release of information.
15. Complies with Network and departmental policies regarding issues of employee, patient and environmental safety and follows appropriate reporting requirements.
16. Demonstrates/models the Network’s Service Excellence Standards of Performance in interactions with all customers (internal and external.)
17. Demonstrates Performance Improvement in the following areas as appropriate: Clinical Care/Outcomes, Customer/Service Improvements, Operational System/Process, and Safety.
18. Demonstrates financial responsibility and accountability through the effective and efficient use of resources in daily procedures, processes and practices.
19. Complies with Network and departmental policies regarding attendance and dress code.
20. Other duties as assigned.
PHYSICAL AND SENSORY REQUIREMENTS:
Sitting for one to two hours at a time, stand for two to three hours at a time, walk on all surfaces for up to five hours per day, and climb stairs. Fingering and handling objects frequently. Occasionally firmly grasp, twist and turn objects with hands and fingers. May be required to lift, carry, push, and/or pull objects weighing up to 75 pounds. Occasionally stoops, bends, squats, kneels and reaches above shoulder level. Must have the ability to hear as it relates to normal conversations and high and low frequencies and to see as it relates to general and peripheral vision. Must have the ability to touch as related to telephone and computer keyboard.
EDUCATION:
Associates or Bachelor’s Degree preferred or health care experience in lieu of education.
TRAINING AND EXPERIENCE:
Demonstrates comprehensive knowledge of computer skills in a variety of software programs, i.e. Microsoft Word, Excel, and PowerPoint. Excellent verbal and written skills required. Ability to prioritize, organize, and support administrator as necessary. Able to work independently.
Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!