Medical Director Revenue Integrity (Lead Physician Advisor)

Job Details

Description

A Day in the Life of a Medical Director Revenue Integrity

The Medical Director of Revenue integrity (Physician Advisor) is a key member of the healthcare organization’s leadership team and is charged with meeting the organization’s goals and objectives for assuring the effective, efficient utilization of health care services. The Physician Advisor is a physician serving the hospital through teaching, consulting, and advising the care management and utilization review departments, healthcare data team and the hospital leadership. The Physician Advisor shall develop expertise on matters regarding physician practice patterns, over and under-utilization of resources, medical necessity, levels of care, care progression, denial management, compliance with governmental and private payer regulations, appropriate physician coding and documentation requirements.

Why Work at Cheyenne Regional?

• 403(b) with 4% employer match
• ANCC Magnet Hospital
• 23 PTO days per year (increases with tenure)
• Education Assistance Program
• Employee Sponsored Wellness Program
• Employee Assistance Program
• Loan Forgiveness Eligible

Here is What You Will Be Doing:

• Provides functional leadership for the revenue integrity team, including CDI, Coding, and Utilization Review (UR).
• Oversees optimization of revenue integrity systems and operations.
• Chairs the Utilization Management (UM) Committee.
• Supports development, adoption, and utilization of value-based care initiatives.
• Reviews patient medical records identified by case managers or as requested by the healthcare team to perform quality and utilization oversight.
• Performs medical necessity reviews including initial level of care, secondary reviews, and continued stay reviews.
• Provides regular feedback to physicians and other stakeholders regarding level of care, length of stay, and potential quality issues.
• Conducts Peer to Peer discussion with Payor Medical Directors when requested.
• Provides necessary clinical education to UR Case Managers regarding clinical criteria and appropriate us of screening tools.
• Educates individual hospital staff physicians about current ICD and DRG coding guidelines.
• Collaborates with CDI and coding team to develop complaint query practices, optimize review process, and provide necessary clinical support in DRG assignment as needed.
• Establishes a reporting system for both outpatient labs and tests, and inpatient medical necessity denials.
• Engages relevant stakeholders and provides necessary education and feedback where necessary to improve processes and decrease denials.
• Conducts physician education sessions to share data, trends, practice patterns, and other relevant information. Documents session outcomes and relevant information.
• Reports practice pattern trends and opportunities to service line or department specific meetings at the request of the CMO or hospital leadership.
• Supports payor contract process and physician contract process for quality measures.
• Participates in efforts to reduce inappropriate readmissions.
• Collaborates with Healthcare Data team to identify areas or processes contributing to excessive cost of care.
• Participates in hospital committees to support and develop protocols related to evidence-based medicine and support optimal standards of care.
• Collaborates with the Chief Financial Officer to identify short term and long-term goals.

Desired Skills:

• Ability to drive strategic direction.
• Knowledge of revenue cycle, clinical documentation, and payor relationships.
• Ability to educate providers and stakeholders in a timely and effective manner.
• Process improvement, planning, and decision-making skills.
• Knowledge of regulatory requirements.
• Ability to interact respectfully with diverse cultural and socio-economic populations.

Here is What You Need:

• State of Wyoming MD or DO license
• Ten (10) or more years of healthcare and/or patient care experience
• Two (2) or more years of healthcare business, revenue cycle, utilization management, coding, clinical documentation improvement principals, or government/ regulatory value programs related experience
• Member of American College of Physician Advisors (ACPA)
• 6 Month: American Board of Quality Assurance & Utilization Review Physicians (ABQAURP) or ACPA Board Certification

Nice to Have:

• Certified Medical Director (CMD)
• Medical billing, coding, or abstracting experience

About Cheyenne Regional:

Cheyenne Regional Medical Center was founded in 1867 as a tent hospital by the Union Pacific Railroad to treat workers injured while building the transcontinental railroad. Today, we are the largest hospital in the state of Wyoming, employing over 2,000 people, and treating over 350,000+ patients from southeastern Wyoming, western Nebraska, and northern Colorado. We pride ourselves on patient and employee experience by living our core values of Integrity, Caring, Compassion, Respect, Service, Teamwork and Excellence to great health.

Our team makes a difference every day by providing trusted healthcare expertise through a passionate and I.N.S.P.I.R.E.(ing) approach with a personal touch. By living our values, we aim to achieve our goal of becoming a 5-star rated hospital, providing critical support and resources to our community and the greater region we serve. If you are eager to make a difference and passionate about healthcare, we encourage you to apply today!

Equal Opportunity Employer

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