PHYSICIAN ADVISOR - SUPPORT

The Physician Advisor \u2013 CDI, Coding \u0026 Quality serves as a key clinical leader supporting Premier Health\u2019s goals to advance documentation accuracy, revenue integrity, and quality performance across the health system. This role focuses on optimizing case mix index (CMI), risk adjustment, and clinical documentation excellence through collaboration with the CDI, Coding, and Quality teams. \n \nThe Physician Advisor provides expert second-level reviews, leads provider education, and partners closely with the CDI Manager, Coding Manager and interdisciplinary teams to ensure that documentation accurately reflects the clinical complexity, severity of illness, and quality outcomes of Premier Health\u2019s patient population.\n\n## Key Responsibilities\n\n### 1\\. Clinical Documentation Integrity (CDI) Leadership\n\n\u2022 Provide secondary review of complex CDI and Coding queries escalated by the CDI and Coding teams. \n\u2022 Review and resolve escalations involving Query disagreement, Clinical Validation, or incomplete response. \n\u2022 Partner with the CDI Manager to establish standardized escalation criteria and ensure timely resolution of all high-impact queries. \n\u2022 Conduct focused \u201csecond-look\u201d reviews of no-CC/MCC or CC-only cases to identify missed documentation opportunities and support CMI improvement. \n\u2022 Serve as a liaison between the CDI, Coding, and Physician teams to promote consistency in documentation practices.\n\n### 2\\. Provider Engagement and Education\n\n\u2022 Conduct one-on-one meetings with providers to review query metrics, patterns, and opportunities for improvement. \n\u2022 Deliver targeted education sessions on documentation best practices, MCC/CC capture, and quality measure alignment. \n\u2022 Participate in residency and faculty education (Internal Medicine, Family Practice, Trauma, Critical Care, etc.) including lectures and QIPS elective rotations on CDI and professional billing documentation. \n\u2022 Partner with the CDI Manager and Quality leadership to develop and disseminate system-wide education tools and tip sheets.\n\n### 3\\. CMI and Quality Improvement\n\n\u2022 Analyze and communicate CMI trends by service line; support interventions to drive improvement aligned with Vizient benchmarks. \n\u2022 Collaborate with Digital Health team to refine dashboards and enable data-driven improvement strategies. \n\u2022 Participate in pre-claim mortality and risk adjustment reviews, focusing on REM score optimization and accurate capture of clinical risk variables. \n\u2022 Support PSI/HAC reviews from a CDI perspective in partnership with Quality and CDI teams.\n\n### 4\\. Interdisciplinary Collaboration\n\n\u2022 Serve as a clinical resource to the CDI, Coding, and Quality departments on complex documentation and regulatory compliance questions. \n\u2022 Partner with Digital Health to support AI-enabled CDI nudges, EHR workflow optimization, and system note-template refinement and creation for service lines. \n\u2022 Contribute to system-wide initiatives related to mortality O/E, LOS O/E, and cost efficiency performance, Vizient facility ranking and Elix Hauser risk adjustment methodologies.\n\n## Performance Expectations\n\n\u2022 Achieve a sizeable conversion rate on escalated CDI/Coding queries. \n\u2022 Demonstrate measurable CMI improvement in targeted service lines. \n\u2022 Support system improvement in key Vizient metrics (Mortality O/E, Cost O/E, LOS O/E). \n\u2022 Maintain provider query agreement rate \u226580% and consistent educational engagement.\n\n \n\nQualifications\n\nEducation: Doctor of Medicine (MD) or Doctor of Osteopathy (DO) required. \n\u2022 Licensure: Active Ohio medical license (or eligibility for licensure). \n\u2022 Experience: \n \u2013 Minimum 3 years of clinical practice experience. \n \u2013 Prior involvement in CDI, and or quality improvement preferred 1-2 years\u2019 experience \n \u2013 Strong working knowledge of ICD-10, MS-DRG/APR-DRG systems, and risk adjustment models Vizient, CMS, Elixhauser etc. \n\u2022 Skills: \n \u2013 Excellent communication and teaching skills. \n \u2013 Ability to interpret clinical and coding guidelines with precision. \n \u2013 Proficiency with EHR systems (Epic experience preferred).\n