Remote Medical Policy Director

Cotiviti; United States; Remote; USD 225,000 - 275,000; Full time

Benefits offered by this job

Medical insurance

401(k) savings plan

Paid time off

Paid holidays

Discretionary bonus

Job summary

Cotiviti is seeking a Client Medical Director to lead medical policy and coding expertise for the Prospective Payment Management client team. Working with the Go To Market team, the CMD will review data, present policy options, and serve as SME for clinical and coding issues.

Based anywhere in the continental United States with up to 10% travel, the CMD partners with the Health Plan, drives client strategy, and supports research and development.

Qualifications

• Licensed MD/DO with clinical and health plan experience.
• Experience in Health plan operations as a Medical Director, focusing on medical policy, coding, payment integrity and/or fraud/waste/abuse.
• Strong client relationship and presentation skills.
• Ability to multitask and manage changing priorities.
• Proficient in Microsoft Office; advanced Excel preferred.

Responsibilities

• Support client growth and identify value-creation opportunities.
• Present payment policy recommendations based on data analytics.
• Define mission and strategy with the Client Engagement Leader; deliver to client’s medical policy team.
• Collaborate with Medical Policy team to evaluate edits.
• Act as clinical liaison with health plan clients.
• Provide guidance to R&D for Medical Policy and Solutions.
• Maintain knowledge of claims, adjudication, policy edits and configurations.
• Deliver value-add analytics and maintain credibility.
• Assist in opportunities for other Cotiviti product sales.
• Other duties as assigned.

Skills

Health plan operations experience

Clinical medicine experience

Client relationship skills

Public speaking

Analytical / problem-solving

Advanced Excel proficiency

Education

MD/DO medical license

Tools

Microsoft Office Suite

Job description

Cotiviti is seeking a Client Medical Director to lead medical policy and coding expertise for the Prospective Payment Management client team. Working with the Go To Market team, the CMD will review data, present policy options, and serve as SME for clinical and coding issues.

Based anywhere in the continental United States with up to 10% travel, the CMD partners with the Health Plan, drives client strategy, and supports research and development.