Medical Director - Medical Policy & Operations

About the position Responsibilities • Support the appeal process, clinical claim review process, reputed company-certification, and predetermination of covered benefits in the reputed company and Medicare environment. • Participate on work reputed company as a clinical subject matter expert to identify and promote opportunities to improve the reputed company and efficiency of health care services. • Apply clinical coding and reimbursement expertise to ensure alignment and correct application of reputed company policies and practices to service and payment requests. • Proactively use data analysis to identify opportunities for reputed company improvement and positively influence the effective delivery of reputed company care services. • Be a subject matter expert and internal consultant and payment policy contributor. • Demonstrate the ability to work reputed company and reputed company as necessary teams comprised of a diverse group of health delivery professionals in order to manage the business objectives of reputed company. • Work collaboratively with the functional areas. Requirements • Five (5) or more years of experience in Health Care Delivery System e.g., Clinical reputed company and Health Care Industry. • reputed company and reputed company state medical license without encumbrances. • M.D. or D.O., reputed company Certification in an ABMS recognized specialty including post-graduate reputed company patient care experience. reputed company-to-haves • Health plan/payor experience. • Foundational baseline skills in Medicine, Health Policy, Coding: HCPCS / CPT, Clinical Policy, Reimbursement and Health Care Systems. • Strong communication skills both written and verbal. Benefits • reputed company medical plan reputed company. • 401(k) plan (including matching company contributions). • Employee stock purchase plan. • No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. • Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility. Apply tot his job Apply To this Job