Medical Director - Clinical Coding & Policy Expert

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

Job summary

RELI Group, Inc. is seeking a Medical Director to lead clinical guidance across federal contracts and support coding, education, and research initiatives.

You will provide expert input on NCCI edits, PTP, MUE and AOC edits, and help resolve complex medical record issues in collaboration with contract teams. Ideal candidates bring board certification, MD/DO with active US license, extensive Medicare/Medicaid coding knowledge, and 3+ years clinical practice, along with experience in health

Qualifications

• MD/DO license active in at least one US state with no sanctions or exclusions
• Board certified for at least 3 years in an ABMS-recognized specialty
• 3 years' experience practicing medicine as a board-certified physician
• Experience in health insurance industry, a utilization review firm, or a health care claims processing organization with compliance responsibilities
• Experience 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

Responsibilities

• Participate in production of NCCI Procedure to Procedure edits, Medically Unlikely Edits, and Add-on code file edits
• Provide clinical input and guidance in work group meetings
• Serve as a clinical subject matter expert to resolve complex medical record issues
• Attend and participate in all contractor meetings
• Demonstrate strong written and verbal communication skills
• Conduct research to support contract inputs
• Prepare research documents for educational materials
• Provide clinical and coding training to contract staff as needed

Skills

Medicare/Medicaid coding policies

HCPCS/CPT codes interpretation

Clinical collaboration

Healthcare research

Medical licensure

Coding certification (preferred)

Education

MD or DO degree

Job description

RELI Group, Inc. is seeking a Medical Director to lead clinical guidance across federal contracts and support coding, education, and research initiatives.

You will provide expert input on NCCI edits, PTP, MUE and AOC edits, and help resolve complex medical record issues in collaboration with contract teams. Ideal candidates bring board certification, MD/DO with active US license, extensive Medicare/Medicaid coding knowledge, and 3+ years clinical practice, along with experience in health