State Licensed Medical Director

Job Summary

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

Key Responsibilities

• Conduct inpatient audits, ensuring billing and coding accuracy through medical record reviews
• Oversee appeals administration by auditing claims and participating in client and provider meetings
• Assist in developing 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
• Coding certification (CCS, CPC, or CIC) preferred or willingness to obtain
• 5+ years of experience using InterQual or MCG/Milliman criteria and decision support group software (3M, etc.)