Anesthesiology Physician

Key Responsibilities

• Conducts medical record review for medical necessity of inpatient admission and quality care management.
• Understands ICD-9-CM, ICD-10-CM/PCS, MS-DRG, APR-DRG, and Medicare Inpatient Prospective Payment System.
• Conducts peer-to-peer reviews with payer medical directors to advocate for medical necessity of denied treatments.
• Reviews and analyzes denied claims to identify opportunities for overturning inappropriate denials.
• Assists in communications of internal physician advisor services to educate medical staff.
• Provides feedback and education to Care Management and Clinical Documentation Departments.
• Attends and participates in facility committee meetings as requested.