Medical Director

Reli Group • Windsor Mill, MD

5d • $275,000 - $290,000

About The Position

The Medical Director represents RELI Group and its partners across federal contracts. The role contributes to fraud prevention, provides clinical guidance to coders, and helps answer questions and resolve complex medical-record issues that arise during contract performance. The Medical Director also provides clinical input in work groups, serves as a clinical subject matter expert, participates in contractor meetings, conducts research to support contracts, prepares research documents for educational materials, and provides clinical and coding training to contract staff as needed.

Requirements

• Doctor of Medicine or Doctor of Osteopathy degree.
• Current, active, valid, and unrestricted license to practice medicine in at least one U.S. state, with no previous sanction or exclusion from the Medicare program.
• Board certified for at least three years as a physician in a specialty recognized by the American Board of Medical Specialties.
• Three years of experience practicing medicine as a board-certified physician.
• Experience in the health insurance industry, a utilization review firm, or another health care claims-processing organization in a role involving compliance responsibilities.
• Experience interpreting HCPCS/CPT codes and coding conventions.
• Extensive knowledge of Medicare and Medicaid payment, coverage, and coding policies.
• Ability to interpret clinical documentation and effectively interpret and resolve disagreements regarding clinical guidelines.
• Advanced knowledge of health care and health care research.
• Ability to collaborate with all levels within the contract.
• Strong written and verbal communication skills.

Nice To Haves

• Coding experience or certification.

Responsibilities

• Participate in work group meetings and provide clinical input and guidance.
• Serve as a clinical subject matter expert to resolve complex medical-record issues.
• Attend and participate in contractor meetings.
• Conduct research to provide input and support across contracts.
• Prepare research documents to support educational materials.
• Provide clinical and coding training to contract staff as needed.
• Contribute to fraud prevention and provide clinical guidance for coders.
• Answer questions and help resolve complex medical-record issues during contract performance.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Ph.D. or professional degree