Medical Director — NCCI & Coding Clinical Lead

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

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.