Physician Advisor

Job Description:

Under general supervision, conducts clinical reviews on cases referred by Clinical Documentation department and/or Coder or Coding leadership to meet regulatory requirements in accordance with the organizational objectives for providing quality patient care and effective utilization of resources. Interacts with medical staff members to discuss clinical documentation, patient severity of illness/risk of mortality and alternative levels of care. Acts as a liaison between Health Information Management (HIM) and the Medical Staff to facilitate accurate and complete clinical documentation, participates in and contributes to the Task Force meetings, and routinely meets with CDI team.

Duties and Responsibilities

Essential Accountabilities:

1. Provides Physician Advisor support to all Wellspan entities as assigned.
2. Reviews medical record documentation concurrently and retrospectively, documents patient care reviews, decisions and other pertinent information.
3. Assists in the development of clinical indicators for highly audited and denied diagnoses, collaborates with physician specialists to set institutional definitions and aids in the creation of compliant queries.
4. May serve as a liaison between Epic Project One, HIM, CDI, Compliance, Population Health and the medical staff to encourage physician cooperation for complete and accurate documentation reflecting the reason that occasioned a patient’s admission and pertinent secondary diagnoses.
5. Analyzes query trends (internal and 3rd party) and documentation data to identify target areas for intervention and to drive performance and process improvement.
6. Completes CDI training and pursues continuous learning as it relates to Documentation, Coding and the Official Coding Guidelines.
7. Provides clinical consultative services to the CDI and Coding teams to assist in establishing the principal and secondary diagnoses and/or the primary thrust of treatment and determine need for Peer-to-Peer review.
8. Provides educational guidance regarding medical conditions and clinical best practice to CDI, coding, and providers (reviewing orientation processes and re-education).
9. Is an active participant in the escalation process and develops strategies and an education plan for providers.
10. Educates providers and/or groups regarding payment methodologies, regulatory requirements, documentation requirements for medical necessity, level of care, length of stay, provider profiling, the correlation between clinical language and coding guidelines, severity of illness (SOI), risk of mortality (ROM), documentation impact on mortality O:E HACs, PSIs, and ensures the documentation supports the code and DRG assignment.
11. Works closely with Epic Project One and physician builders to evaluate documentation template changes to improve documentation.
12. Works closely with Population Health and provider leadership to the evaluate problem list and documentation throughout the continuum of care to ensure the complexity of the patient is captured properly.
13. Works closely with coding leadership to evaluate ways to improve documentation in the various hospital settings. (I.e., inpatient, observation, ambulatory surgery, interventional radiology, cardiology, etc.)
14. Works closely with the coding and CDI leadership to review denial trends and patterns. Helps to evaluate documentation template changes with Epic Project One and physician builders to ensure accurate documentation.

NonEssential Accountabilities:

1. Prepares and presents utilization data analysis as required.
2. Develops and initiates educational programs regarding utilization management principles.
3. Assists with special projects as needed.
4. Attends meetings as required.
5. Performs other related duties as needed.

Common Expectations:

1. Acts in a professional manner and uses a “Just Culture” approach in interactions with the hospital and medical staff.
2. Provides outstanding services to all customers, fosters teamwork and practices fiscal responsibility through improvement and innovation.
3. Advocates for a culture of integrity.
4. Demonstrates the ability to lead and provide constant feedback and encouragement to peers.
5. Is a leader in compliant documentation.

Qualifications

• Minimum Experience:
  • 5 or more years of recent clinical experience in hospital medicine
  • Pref Field of ExpertiseInternal Medicine, Hospitalist, Peer Review, Case Management
• Minimum Education:
  • M.D. or D.O.
• Required Certification:
  • Licensed to practice medicine or osteopathy without restriction in Pennsylvania, Diplomate of an appropriate specialty Board
• Physical Demands:
  • Mostly sedentary work, no direct patient care
  • Occasional prolonged standing/walking
• Skills:
  • Strong interpersonal skills, excellent communication skills (verbal, written, and listening), strong analytical skills, and an understanding of coding classification assignments and reimbursement methodologies