Hca Utilization Review Jobs in Tennessee (NOW HIRING)

This Work from Home position requires that you live and will perform the duties of the position; within 60 miles of an HCA Healthcare Hospital (Our hospitals are located in the following states: FL, GA, ID, KS, KY, MO, NV, NH, NC, SC, TN, TX, UT, VA).

Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized. Submit your application for the opportunity below: Physician Advisor Coordinator 

Job Summary and Qualifications

The Physician Advisor Coordinator will assist in establishing communication between Physician Advisors and in-house insurance Medical Directors for the purposes of ensuring Physician Advisors peer to peer work efforts with external health plans. This individual will be responsible for maintaining reports of outcomes and system process flows between multiple enterprise teams such as Case Management, Corporate Utilization Review Services (URS) team, Pre-bill Denial Units (PDU), and on Authorization and Medical Necessity Denials. 

What you will do in this role:

• Responsible for setting up and coordinating Peer to Peer (P2P) reviews for Physician Advisors (PA) 
• Work with URS and Division PA’s on denial and P2P strategies 
• Manages multiple calendars and sending/receiving appointment invites through Outlook 
• Maintain knowledge of commercial payer denial, authorization strategies/ practices, and contractual agreements 
• Possess current knowledge of CMS, Corporate and Division UR requirements and billing procedures 
• Monitor P2P’s and observation (OBS) vs inpatient (IP) cases 
• Monitor and update MIDAS with pertinent information 
• Prepare monthly P2P reports from multiple data sources 
• Maintain P2P impact report for the Physician Advisors 

What qualifications you will need:

• College degree preferred
• Minimum 2-3 years of healthcare experience preferred

Benefits

HCA FL Twin Cities Transport, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
• Wellbeing support, including free counseling and referral services
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
• Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"There is so much good to do in the world and so many different ways to do it."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder

If you find this opportunity compelling, we encourage you to apply for our Physician Advisor Coordinator opening. We promptly review all applications. Highly qualified candidates will be directly contacted by a member of our team. We are interviewing - apply today!

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.