Position Title:  Provider Advisor

Location: St. Mary Medical Center - Hobart, IN 46342

 

Position Summary:

The Provider Advisor will provide clinical expertise to support utilization management (UM) and quality initiatives within the healthcare setting. Key responsibilities include conducting clinical reviews, consulting with Physicians on patient status and resource use, collaborating with care management and health information management (HIM) to improve documentation and coding, and acting as a liaison with third-party payers for appeals and authorizations. The goal is to ensure accurate reimbursement, efficient use of hospital services, adherence to regulations, and ultimately, better patient care and outcomes.

Education & Experience Requirements:

 

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  Graduate of an accredited Physician Assistant (PA) school.  Completion of an Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) approved program.

  
  


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  Current certification by the National Commission on Certification of Physician Assistants (NCCPA).

  
  


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  Current active licensure to practice as a PA in the State of Indiana.

  
  


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  Board Certification is required to be granted necessary hospital privileges for employment.

  
  


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  Maintain active CPR certification.

  
  


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  Minimum of 5 years of medical clinical practice or previous role as Provider Advisor.

  
  


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  Knowledge of and ability to apply professional medical principles, procedures, and techniques.

  
  


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  Excellent verbal and written communication skills to communicate effectively with other physicians, staff, patients, payors, etc.

  
  


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  Effective ability to communicate recommendations or suggestions in a balanced way to the Physicians and staff.

  
  


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  Experience in hospital process; i.e., utilization management, case management, clinical care protocols, and coding and billing with strong knowledge of regulatory requirements such as CMS and Joint Commission and payor guideline.

  
  


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  Maintain concise, timely, and accurate confidential records of patients.

  
  


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  Ability to analyze complex clinical and administrative data and provide actionable recommendations.

  
  


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  Good time management skills.  Strong decision making and practice skills.