Medical Director – Medical Policy Ops-DRG

This is a fully remote position, open to applicants in Connecticut.

📋 Description

• Delivering clinical expertise to enhance the provision of high-quality, patient-centered medical care

• Assisting in the appeals process through detailed transactional reviews

• Executing the clinical claim review process and pre-determining eligible benefits

• Utilizing expertise in clinical coding and reimbursement

• Partnering with various functional areas to enhance the quality and efficiency of healthcare services

• Employing data analysis for continuous quality improvement

⛳️ Requirements

• A minimum of five (5) years of experience in the Health Care Delivery System, such as Clinical Practice and the Health Care Industry.

• A current and active state medical license without any encumbrances.

• M.D. or D.O. with Board Certification in an ABMS-recognized specialty, including direct patient care experience during post-graduate education.

• Experience with health plans or payors.

• Foundational skills in Medicine, Health Policy, Coding (HCPCS / CPT), Clinical Policy, Reimbursement, and Health Care Systems.

• Proficiency in DRG reviews.

• Excellent written and verbal communication skills.

🏝️ Benefits

• Medical, dental, and vision coverage

• Paid time off

• Retirement savings options

• Wellness programs

• Additional resources