Redefining Healthcare with AI
Xsolis is an AI-driven technology company reducing administrative waste in healthcare by enabling smarter collaboration between providers and payers. Since 2013, our vision has been to create a frictionless healthcare system.
We are proudly headquartered in Franklin, TN - one of the nation's fastest-growing hubs for healthcare innovation - we are at the heart of a thriving ecosystem of health systems, payers, and technology leaders.
Our flagship product, Dragonfly®, is the first and only AI-driven platform to continuously assign real-time predictive scores for medical necessity. Dragonfly has delivered proven results across 600+ hospital, health system, and health plan clients and earned repeated industry recognition. With recognition on the Inc. 5000 and Deloitte Technology Fast 500 lists, Xsolis is also one of the fastest-growing privately-held companies in the country and across North America, and we're looking for talented people to grow with us.
Position Summary Details
Physician Advisors provide concurrent review and appeal support services for XSOLIS’s XPAS client base. Physician Advisors should possess professional expertise and the desire to be a part of an organization with proven experience to innovate, execute and deliver. Experience with utilization management and understanding of state and federal regulations, knowledge about the denials and appeals process, and experience with physician documentation and electronic health records is key. Physician Advisors apply practical working knowledge as a Physician Advisor to a solution that will change the way hospitals solve their administrative challenges.
Essential Duties & Responsibilities
The essential functions include, but are not limited to the following:
- Provide clinical reviews in accordance with Managed Care and CMS Regulatory Requirements to:
- Assist with level of care and length of stay management on a case-by-case basis
- Assist with the denial management process
- Determine if professionally recognized standards of quality care are met
- Participate in the concurrent and retrospective appeal peer-review process"
- Provide feedback to internal and external partners regarding level of care, length of stay and quality issues, which may also include joining client meetings to review observations and trends in physician behavior and/or documentation. Recommend and request additional, more complete, medical record documentation. Provide guidance to internal and external staff regarding status issues and alternatives to acute level of care when such care is not warranted. Provide education to internal and external staff related to regulatory requirements, appropriate utilization, and alternative levels of care.
- Ensure appropriate documentation of patient care reviews, decisions, and other pertinent information. Be able to review cases with screening criteria, such as InterQual, MCG or other appropriate platforms. Develop and apply protocols related to evidence-based medicine and criteria.
- Work with internal and external Care Management staffs to ensure appropriate continuity of care and provide education to assist in reducing readmissions.
- Educate internal and external staff about ICD coding guidelines (e.g., co-morbid conditions, outpatient vs. inpatient) and clinical terminology to improve their understanding of severity, acuity, risk of mortality, and DRG assignments on their individual patient records.
- Provide insight into the development of the XSOLIS appeal operations and technology platform. Work with the Data Analytics team and assist in the enhancement of clinical analytics.
- Maintain current knowledge of federal, state, and payer regulatory and contract requirements.
- Additional functions as deemed appropriate and warranted.
- Full-time physician advisors are required to complete peer to peer reviews
Minimum Qualifications (Knowledge, Skills, and Abilities)
Education:
- Graduate of an accredited medical school
- Additional education in quality and utilization management through continuing medical education programs and self-study
Experience:
- 5 years recent experience in clinical practice
Other:
- Utilization management experience as a member of the UM oversight committee or past physician advisor experience preferred
- Licensed physician without restrictions
- Knowledge of federal, state, and payer regulatory and contract requirements
- Verbal and written communication skills
- Basic computer skills, including typing, navigating browsers, etc.
- MS Office Suite
- Professional demeanor and interpersonal skills
Supervisory Responsibilities
This role does not have any direct reports and is a single contributor role.
Working Environment and Travel Requirements
- Work is typically in a normal office administrative environment involving minimal exposure to physical risks.
- Position requires little to moderate physical activity. Mostly sedentary work exerting up to 10 pounds of force occasionally or a negligible amount of force to lift, carry, push, pull, or otherwise move objects. Work involves sitting most of the time, but may involve walking or standing for brief periods of time. No significant stooping is usually required.
- This role requires travel to our home offices in TN for training.
Physical Demands & Work Environment
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position.
Reasonable accommodations may be made to enable individuals with disabilities to perform the functions.
In any role at Xsolis, it's a chance to make a complex healthcare system a little more efficient alongside a team that's passionate, fast-moving, and genuinely invested in your success. Your contributions will shape both our product and our culture.
Full-time Employees’ Total Rewards package include:
- Medical/Dental/Vision insurance
- Educational reimbursement program
- Employer-paid EAP & Mental Health services
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Xsolis is proud to be an equal opportunity employer. We celebrate diversity and are committed to building an inclusive environment for all. We encourage candidates of every background to apply.
All candidates must successfully pass a background check and fall under the same security role, which includes access to sensitive information, including proprietary data and PHI.
Work Authorization Notice: Please note that we do not provide visa sponsorship or immigration support for this position. Applicants must already be authorized to work in the United States on a full-time, permanent basis without the need for current or future sponsorship.
All official communications from our recruitment team will only come from @xsolis.com. Verify open roles at https://www.xsolis.com/about/careers. For information regarding how we collect, use, and protect applicant personal information, please review our CCPA Privacy Notice for Job Applicants.
