Covenant Health

Physician Advisor Operations Coordinator, Revenue Integrity and Utilization

PRN/OCC, Variable Hours, Day Shift

Covenant Health Overview:

Covenant Health is the region’s top-performing healthcare network with 10 hospitals, outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned integrated healthcare delivery system and the area’s largest employer. Our more than 11,000 employees, volunteers, and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we serve every year. Covenant Health is the only healthcare system in East Tennessee to be named a Forbes “Best Employer” seven times. 

Position Summary:

The Physician Advisor Operations Coordinator will perform activities to help facilitate utilization management functions related to the coordination of physician advisor related activities. Prepares necessary documentation for insurance utilization management processes and coordinates communication between members of the UM team to ensure timely follow through.  Maintains electronic utilization management database for statistical and educational reporting as well as work flow. Facilitates appropriate collection of data so as to ensure appropriate reporting. Manages physician’s schedules as well as payroll. Coordinates physician advisor calendars in relation to all meetings. Must be extremely organized since managing data and schedules is a significant portion of the position. Manages the Utilization Management call center including returning calls to patients, physicians, and payors. Distributes patient and physician letters when there are peer-to-peer activities that must be managed. For downgraded accounts, facilitates correct patient status assignment including observation hour calculations. Assists with appeal’s coordination as applicable.

Recruiter: Kathleen Rice || kkarnes@covhlth.com || 865-374-5386

• Assists RN Physician Liaison in setting up communications with payors and/ or physicians as applicable.
• Monitors denials as well as all financial metrics associated with front-end review process. Root causes breakdowns in process relating to denials.
• Maintains a monthly data report on each physician’s activities impacting Utilization Management activities.
• Manages physician advisor reports and assists with facilitating UM Committee reviews when applicable.
• Exhibits expertise in utilization management related activities including but not limited to:
  • Knowing Medicare rules and regulations related to utilization
  • Knowing payor policies related to utilization management
  • Knowing Covenant Health’s Policies related to utilization management.
  • Keeping abreast of current changes affecting utilization management as applicable.
• Prepares notices (denials) of non-coverage when appropriate and facilitates communication between key stakeholders to ensure that patient liability is correctly managed.
• Keeps abreast of current changes affecting Utilization Review as applicable.
• Adjusts patient type changes and charges for Observation Hours in STAR as applicable.
• Assist with all insurance requested audits and provides information to supervisor related to inaccurate and/or missing documentation as applicable.
• Attends meetings as required and participates on committees as directed
• Performs other related duties as assigned or requested.
• Motivates coworkers and promotes a team effort in accomplishing goals and deadlines with accuracy, dependability and professionalism.
• Supports, models and adheres to desired behaviors of the KBOS Constitution for caring which are; build a trusting environment by listening with an open mind and valuing different opinions; asking questions for understanding and allowing others to speak openly, do not gossip or criticize people behind their back, resolve conflicts, notice and express appreciation for good work and respect differences by listening with an open mind
• Supports, models and adheres to the desired behaviors of the KBOS Constitution and Covenant Health for service which are; take ownership for our mistakes, resolve customer problems on the spot whenever possible, treat all people with respect and kindness, strive to meet or exceed customer expectations, collect and use customer feedback/data to improve processes and service and set an example for accountability and responsiveness: return e-mail and phone calls promptly, assure deadlines are met, keep commitments

Minimum Education:          

Bachelor’s degree in business administration or similar required

Minimum Experience:         

Minimum of five (5) years’ experience with at least three (3) years of healthcare experience. Business operations experience preferred

Licensure Requirements:    

None