Medical Director

RELI Group, Inc.; United States; On-site; USD 240,000 - 280,000; Full time

Job summary

RELI Group, Inc. is seeking a Medical Director to represent RELI Group and its partners on federal contracts. You will contribute to fraud prevention through PTP, MUE and AOC edits, support the NCCI contract, and provide clinical guidance for coders.

You will address complex medical record issues, participate in contractor meetings, and train contract staff as needed while leveraging extensive Medicare/Medicaid policy expertise.

Qualifications

• Extensive knowledge of Medicare and Medicaid payment, coverage, and coding policies; interpreting clinical documentation and resolving disagreements regarding clinical guidelines.
• Doctor of Medicine or Doctor of Osteopathy Degree.
• Current active, valid, and unrestricted medical license in at least one US state with no sanctions or exclusions.
• Board certification for at least 3 years in an ABMS-recognized specialty.
• Three years' medical practice as a board-certified physician.
• Experience in health insurance industry or claims processing with compliance responsibilities.
• Experience interpreting HCPCS/CPT codes and coding conventions.
• Advanced knowledge of health care research.

Responsibilities

• Participate in the production of NCCI Procedure to Procedure edits, Medically Unlikely Edits, and Add-on code file edits.
• Provide clinical input in work group meetings and serve as clinical SME to resolve complex medical record issues.
• Attend and participate in contractor meetings.
• Demonstrate strong written and verbal communication skills.
• Conduct research to support contract input and education materials.
• Provide clinical and coding training to contract staff as needed.

Skills

Medicare/Medicaid coding

Board-certified physician

Clinical guidelines interpretation

HCPCS/CPT coding

Medical licensure (state)

Healthcare claims processing

Medical research knowledge

Collaboration 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.

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 / Affirmative 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