Federal Medical Director: Clinical Policy & Coding

RELI Group Inc; Milford Mill (MD); On-site; USD 275,000 - 290,000; Full time

Job summary

RELI Group Inc. is seeking a Medical Director to represent the organization and its partners on federal contracts.

You will provide clinical guidance for coders, contribute to fraud prevention, and help resolve complex medical record issues that arise during contract performance. Responsibilities include participating in workgroup meetings, serving as a clinical SME, and delivering training while ensuring compliance with Medicare and Medicaid policies.

Qualifications

• MD or DO degree with active license in at least one US state, no sanctions.
• Board certification for at least 3 years as a physician.
• Three years’ clinical practice as a board-certified physician.
• Experience in health insurance/claims processing with compliance responsibilities.
• Experience interpreting HCPCS/CPT codes and coding conventions.

Responsibilities

• Participate in work group meetings to provide clinical input and guidance.
• Serve as a clinical subject matter expert to resolve complex medical record issues.
• Attend and participate in all contractor meetings.
• Conduct research and prepare documents to support educational materials.
• Provide clinical and coding training to contract staff as needed.
• Apply extensive Medicare/Medicaid policy knowledge to guidance and decisions.

Skills

Strong written and verbal comms

Clinical guidance for coders

Fraud prevention

Collaboration across levels

HCPCS/CPT codes interpretation

Education

Doctor of Medicine or Doctor of Osteopathy Degree

Board certification (3+ years)

Job description

RELI Group Inc. is seeking a Medical Director to represent the organization and its partners on federal contracts.

You will provide clinical guidance for coders, contribute to fraud prevention, and help resolve complex medical record issues that arise during contract performance. Responsibilities include participating in workgroup meetings, serving as a clinical SME, and delivering training while ensuring compliance with Medicare and Medicaid policies.