Licensed Medical Director

Job Summary

A company is looking for a Medical Director (Clinical Chart Validation Team).

Key Responsibilities

• Conduct inpatient audits and ensure billing and coding accuracy through thorough medical record reviews
• Oversee appeals administration by auditing claims and participating in client meetings to discuss findings
• Assist in research and development of medical policy edits and support quality assurance program implementation

Required Qualifications

• Must be a licensed physician with 5+ years of clinical experience, preferably in an inpatient setting
• Experience as a Medical Director in private sector health plan operations, focusing on chart review and medical coding
• Preferred experience in DRG auditing and coding certification (CCS, CPC, or CIC)
• 5+ years of experience using InterQual or MCG/Milliman criteria and decision support group software (3M, etc.)