Federal Medical Director: Coding & Clinical Policy Leader

Physician Pivot; Baltimore (MD); On-site; USD 240,000 - 280,000; Full time

Benefits offered by this job

HUBZone eligible

Benefits package

Job summary

RELI Group is seeking a Medical Director to represent the organization and its partners on federal contracts. You will contribute to fraud prevention through medical coding edits, provide clinical guidance for coders, and help resolve complex medical record issues that arise during contract performance.

Key responsibilities include participating in NCCI edits, offering clinical SME input, and training contract staff. This role demands strong communication and collaboration across teams.

Qualifications

• Extensive knowledge of Medicare and Medicaid payment and coding policies.
• Active license to practice medicine in at least one US state with no sanctions.
• Board certified for at least 3 years in a specialty recognized by ABMS.
• Three years’ experience practicing medicine as a board-certified physician.
• Experience in health insurance industry or claims processing with compliance duties.
• Experience interpreting HCPCS/CPT codes and coding conventions.
• Advanced knowledge of health care research.
• Ability to collaborate with all levels within the contract.
• Coding experience/certification preferred.

Responsibilities

• Participate in production of NCCI Procedure-to-Procedure edits and related coding edits.
• Provide clinical input in work groups and guidance sessions.
• Serve as clinical subject matter expert to resolve complex medical record issues.
• Attend and participate in contractor meetings.
• Maintain strong written and verbal communication.
• Conduct research to support educational materials for contract needs.
• Provide clinical and coding training to contract staff as needed.

Skills

Medicare/Medicaid policy understanding

Clinical guidance & coding knowledge

Cross-functional collaboration

Excellent communication

Education

MD or DO degree

Job description

RELI Group is seeking a Medical Director to represent the organization and its partners on federal contracts. You will contribute to fraud prevention through medical coding edits, provide clinical guidance for coders, and help resolve complex medical record issues that arise during contract performance.

Key responsibilities include participating in NCCI edits, offering clinical SME input, and training contract staff. This role demands strong communication and collaboration across teams.