Medical Director
About The Position
At RELI Group, our work is grounded in purpose. We partner with government agencies to solve complex challenges, improve public health, strengthen national security, and make government services more effective and efficient. Our team of over 500 professionals brings deep expertise and a shared commitment to delivering meaningful outcomes. Behind every solution is a group of experts who care deeply about impact—whether we’re supporting data-driven decisions, modernizing systems or safeguarding critical programs. As Medical Director you will be responsible for representing Reli Group and it's partners across federal contracts. You will be responsible for contributing to fraud prevention through making and editing PTP, MUE and AOC edits, supporting the NCCI contract, providing clinical guidance for coders, and helping answer questions and resolve complex medical record issues that may arise during the performance of the contracts.
Requirements
- Extensive knowledge of Medicare and Medicaid payment, coverage, and coding policies
- Interpreting clinical documentation and capable of effectively interpreting and resolving disagreements regarding clinical guidelines.
- Doctor of Medicine or Doctor of Osteopathy Degree
- Current active, valid, and unrestricted license practice medicine in at least one US state with no previous sanctioning or exclusion from the Medicare program
- Board certified for at least 3 years as a physician in a specialty recognized by the American Board of Medical Specialties
- Three years’ 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 that involved compliance responsibilities
- Experience in interpreting HCPCS/CPT codes and coding conventions
- Extensive knowledge of Medicare and Medicaid payment, coverage and coding policies
- Advanced knowledge of health care and health care research
- Ability to collaborate with all levels within the contract
Nice To Haves
- Coding experience/certification
Responsibilities
- Participate in the production of NCCI Procedure to Procedure edits, Medically Unlikely Edits, and Add-on code file edits
- Participate in work group meetings to provide clinical input and guidance
- Serve as a clinical subject matter expert to resolve complex medical record issue
- Attend and participate in all contractor meetings
- Must have strong written and verbal communication skills
- Conduct research to provide input and support across contract
- Prepare research documents to support educational materials
- Provide clinical and coding training to contract staff as needed
Benefits
- RELI Group provides a variety of additional benefits to its employees.
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What This Job Offers
Job Type
Full-time
Career Level
Executive
