Physician Advisor – Peer to Peer, Level of Care
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Physician Advisor reviewing denied payor authorizations for R1’s healthcare revenue-cycle solutions. Evaluating documentation, advising clients, and conducting peer-to-peer discussions with medical directors.
Responsibilities:
- Review payor peer-to-peer cases for authorization denials
- Evaluate whether proper documentation supports the requested admission status, procedure, and care setting
- Advise client facilities on the appropriateness of requests based on available documentation
- Discuss cases with payor medical directors
- Address authorization requests, documentation support, evidence-based criteria, and complex clinical evaluations
- Review and respond to payors and customers in a timely manner
- Engage payor medical directors regarding authorization status supported by documentation
- Provide written case analyses and perform reviews across multiple specialties
- Serve as a clinical resource to medical and case management staff
- Identify, facilitate, and resolve documentation and utilization issues
Requirements:
- Active, unrestricted MD or DO medical licensure
- Minimum 3+ years of clinical experience post-residency completion
- Strong clinical knowledge across multiple clinical areas
- Ability to work independently with a high level of performance in a rapidly changing, fast-paced environment
- Proficiency in basic computer skills
- Ability to review authorization denials, documentation, evidence-based criteria, and complex clinical requests across multiple specialties
Benefits:
- Annual bonus plan at a target of 10.00%
- Competitive benefits package
- Opportunities to constantly learn, collaborate across groups, and explore new career paths
- Opportunity to contribute, think boldly, and create meaningful work
- Reasonable accommodation support for applicants with disabilities
Similar Jobs
Revenue Cycle Specialist II – Physician Billing
Revenue Cycle Specialist II supporting Cedars-Sinai’s healthcare billing operations. Reviewing claims, managing payer follow-up, and resolving patient accounts remotely.
Médico Urgencias, Temporal
Médico/a de urgencias ofreciendo atención y orientación por telemedicina. Teladoc Health International conecta pacientes con servicios de asistencia sanitaria virtual.
Front Desk Medical Receptionist – Family Medicine
Remote Front Desk Medical Receptionist supporting a U.S. Family Medicine practice. Managing AthenaHealth scheduling, benefits verification, patient intake, and Medicare patient communications.
Collaborating Physician
Georgia-based collaborating physician providing clinical oversight, chart review, and regulatory support. Guiding Nurse Practitioners serving Medicaid, Medicare, and dual-eligible populations.
Obstetrician-Gynecologist – OB/GYN
Board-certified OB/GYN evaluating AI-generated obstetrics and gynecology answers for Mercor’s health AI projects. Reviewing patient charts, judging clinical safety, and writing structured rationales.
Radiologist
Board-certified radiologist evaluating AI-generated radiology answers for Mercor’s health AI projects. Reviewing patient charts, writing clinical rationales, and flagging patient-safety risks.
Radiologist
Diagnostic radiologist supporting Radiology Affiliates Imaging’s Wilkes-Barre and Scranton hospitals. Delivering diagnostic and interventional care with AI-enhanced imaging technology.
Radiologist
Diagnostic Radiologist delivering diagnostic, mammography, and interventional radiology services across Wilkes-Barre and Scranton. Joining Radiology Partners’ physician-led practice with AI-enhanced technology and partnership opportunities.
Clinical Survey Research & Methodology Expert, Physician/PhD
Clinical survey expert refining physician-focused healthcare market research surveys for Mercor. Applying medical expertise to improve AI systems and research quality.
Clinical Survey Research & Methodology Expert – Physician, PhD
Clinical survey expert designing and validating physician-focused healthcare research surveys for Mercor. Translating medical expertise into high-quality data for AI training projects.
Médico/a urgencias – Temporal
Médico/a de urgencias remoto para Teladoc Health International, líder mundial en asistencia sanitaria virtual. Evaluación, orientación y coordinación de recursos médicos mediante telemedicina.
Virtual Medical Doctor – Telemedicine
Virtual doctor delivering AI-assisted consultations through AISHA’s WhatsApp health platform. Providing triage, treatment guidance, documentation, and escalation to physical care.
Clinical Survey Research, Methodology Expert – Physician/PhD
Clinical survey expert refining physician-focused healthcare market research surveys for Mercor. Translating medical expertise into accurate questionnaires supporting AI system training.
Clinical Survey Research Expert – Physician, PhD
Clinical survey expert designing and validating physician healthcare surveys for Mercor. Supporting AI labs and enterprises by applying clinical and market research expertise.
Clinical Survey Research Expert – Physician, PhD
Clinical survey expert refining physician-focused healthcare research surveys for Mercor. Improving medical accuracy, methodology, and data quality for AI training projects.
Physician
Family Medicine Physician delivering remote text and video consultations through LifeMD's virtual primary care and weight loss platform. Prescribing treatments and overseeing ongoing patient care.
Outpatient Neurologist – Memory & Cognitive Disorders
Behavioral neurologist delivering virtual dementia diagnosis and longitudinal care through Remo’s patient-and-caregiver clinic. Leading interdisciplinary teams and improving technology-enabled dementia care.
Physician Advisor
Physician Advisor conducting clinical reviews and utilization guidance for Med-Metrix. Improving medical necessity decisions, documentation, coding, and denial prevention.
Access Physician
Part-time remote hospice physician determining patient eligibility and certifications. Supporting admissions, comfort medications, regulatory compliance, and access to Chapters Health care.
Access Physician
Part-time remote Access Physician supporting Chapters Health System’s hospice admissions and eligibility determinations. Providing physician certifications, medication orders, clinical documentation, and admissions guidance.