Florida Licensed Medical Director

Job Summary

A company is looking for a Medical Director Payment Integrity Officer (PIO).

Key Responsibilities:

• Provide clinical support to ensure compliance with clinical standards in fraud, waste, and abuse efforts
• Review cases for billing accuracy and medical necessity, applying medical policy and clinical guidelines
• Support anti-fraud programs and participate in reviews and audits related to alleged fraud and abuse

Required Qualifications:

• MD or DO with an unrestricted Florida medical license
• 3+ years of experience in active clinical practice, preferably in primary care
• Experience in utilization management, case review, and quality improvement in a managed care setting
• Conversant with CPT coding, medical claims review, and hospital billing
• Preferred board certification in a recognized specialty or relevant certifications in coding