Medical Director

RELI Group, Inc.; Baltimore (MD); On-site; USD 240,000 - 280,000; Full time

Job summary

RELI Group is seeking a Medical Director to lead clinical policy across federal contracts and to represent the company with partners. The role includes guiding coding policy, editing PTP, MUE and AOC edits, and contributing to fraud prevention efforts across NCCI contracts.

You will provide clinical direction to coders and help resolve complex medical record issues arising during contract performance. Strong collaboration across teams is essential.

Qualifications

• Extensive knowledge of Medicare and Medicaid payment, coverage, and coding policies.
• Board certified for at least 3 years in a physician specialty recognized by the ABS.
• Current active license to practice medicine in at least one US state with no sanctions or exclusions.

Responsibilities

• Represent RELI Group and its partners across federal contracts.
• Contribute to fraud prevention through creating and editing PTP, MUE and AOC edits.
• Provide clinical guidance for coders and resolve complex medical record issues.
• Participate in contract research and educational material development.
• Communicate effectively with contract staff and stakeholders.

Skills

Medicare/Medicaid coding

Clinical leadership

Communication skills

Education

MD/DO degree

Job description

About Us

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.

Description

About Us

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.

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

Qualifications

• 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
• Coding experience/certification (preferred)

EEO Employer

RELI Group is an Equal Employment Opportunity / Affimative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

HUBZone

We encourage all candidates who live in a HUBZone to apply. You can check to see if your address is located in a HUBZone by accessing the SBA HUBZone Map.

The annual salary range for this position is $240,000 to $280,000. Actual compensation will depend on a range of factors, including but not limited to the individual’s skills, experience, qualifications, certifications, location, other business and organizational needs, and applicable employment laws. The estimate displayed represents the typical salary range for this position and is just one component of the total compensation package for employees. RELI Group provides a variety of additional benefits to its employees. For additional details on the benefits that RELI Group offers click here