State 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
• Oversee appeals administration and participate in client meetings to discuss audit findings
• Assist in the development of medical policy edits and support quality assurance programs

Required Qualifications

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