We are seeking a Physician Denial Advisor for our center to ensure that we continue to provide all patients with high quality, efficient care. We are an amazing team that works hard to support each other and are seeking a phenomenal addition like you who feels patient care is as meaningful as we do. We want you to apply now!
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.
Healthcare Corporation of America (HCA) is a community of 94,000 Registered Nurses and 38,000 active physicians. We have over 1,900 facilities ranging from hospitals, freestanding ER’s, ambulatory surgery centers, and urgent care clinics. Our facility based staff continues to raise the bar in patient care. Ten HCA hospitals have been named in IBM Watson Health’s top 100 best-performing hospitals based on patient satisfaction and operational data.
HealthONE® is the largest healthcare system in the metro Denver area with more than 10,000 employees. As part of the HealthONE family, The Medical Center of Aurora, 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 seven free-standing emergency departments, numerous ambulatory surgery centers, CareNow Urgent Care Clinics & Occupational Medicine, physician practices, and AIRLIFE-DENVER, which provides critical care air and ground transportation across a 10-state region.
We are committed to each other because when we join together, our patients are cared for in the safest and most compassionate way. Are you looking for an employer with many different career options and a people-focused culture? You've come to the right place.
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 CPP 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.
•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: •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.
•If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply. We promptly review all applications. If you are highly qualified you will hear from one of our managers. Come unlock the possibilities and apply today!
•Licensed (or eligible for licensure) in the State of Colorado as an M.D. or D.O.
or 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
•Minimum 10 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.
•PREFERRED experience in implementation of CPOE and EMR (e.g., Horizon Patient Folder products).
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
Join our HealthONE family -- the largest healthcare system in the Denver metro area. Eight world-class hospitals. 40+ outpatient facilities. Countless opportunities.HealthONE is an equal opportunity employer.