Physician Advisor Appeals

The Physician Advisor (PA) with an appeals focus is responsible for reviewing payor denials and authoring an appeal letter when an appeal is supported. The PA will support Medical Necessity denials, Clinical Validation denials and limited DRG denials. The PA will work with the Brundage Group Clinical Appeal Specialists and provide oversight to their work. The PA should have strong clinical experience and denials experience to author compelling arguments based on clinical documentation in the health record, coding guidelines (when applicable) and the payor policies.

The PA will also interact with medical directors of third-party payers to discuss denials and perform P2Ps when necessary.


Denials Management Functions:

  • Perform peer to peers with payors.
  • Act as a liaison with payors to facilitate approvals and prevent denials or carved out days when appropriate.
  • Manages denial review work queues for assigned clients.
  • Performs chart reviews to evaluate the validity of payor denials to determine if an appeal is warranted.
  • Collaborates with a Clinical Appeals Specialists on authored appeals.
    • Participates in client calls to support the client relationship and company meetings as needed.
    • Works collaboratively with operations, client engagement and clinical account executives to ensure cases are received in a timely manner and processed accordingly to meet payor deadlines.
    • Provides input and recommendations to Brundage Group management for process improvement.
    • Maintain IT access to client sites.
    • Maintains HIPAA compliance.
    • Responsible for other duties as assigned or requested.
    • Other duties as assigned.


  • MD or DO
  • Current, unrestricted medical license in state of residence
  • Demonstrated ability to build rapport with medical staff and hospital leadership
  • Prior Physician Advisor experience authoring appeal letters
    • Preferred Qualifications:

      • Board Certified / Eligible
      • CCDS or CDIP
      • CCS
      • CHCQM certification (ABQAURP)
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