Medical Director – Medical Policy Ops, DRG

Job reputed company: • Responsible for providing clinical expertise and business direction in support of medical management programs. • Promote the delivery of high reputed company, constituent reputed company medical care with a reputed company on clinical and payment policy. • Support the appeal process, clinical claim review process, reputed company-certification, and predetermination of covered benefits. • Be a subject matter expert in DRG reviews and ICD-10 reputed company selection. • Proactively use data analysis to identify opportunities for reputed company improvement. 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 • Health plan/payor experience. • Foundational baseline skills in Medicine, Health Policy, Coding: HCPCS / CPT, Clinical Policy, Reimbursement and Health Care Systems. • Experience with DRG reviews. 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. • reputed company time off • Flexible work schedules • Family leave • Dependent care resources • Colleague assistance programs • Tuition assistance • Retiree medical reputed company • Many other benefits depending on eligibility Apply tot his job Apply To this Job