General Purpose
We are seeking an Associate Medical Director with a background in surgery to join our medical bill review company. In this role, you will provide clinical expertise in reviewing medical claims, ensuring accuracy in billing, and collaborating with internal teams to maintain high standards of payment integrity. In addition to having appropriate surgical knowledge and experience, we are seeking candidates who are confident and have a willingness to learn. Good communication skills and ability to work with others outside of the medical review department are essential. You will report to the Chief Medical Officer.
Duties & Responsibilities
- Provides expert analysis of medical records, a thorough understanding of medical issues, the appropriate medical treatments, and associated billed charges.
- Understands and maintains current industry knowledge on reimbursements’ operational aspects and workflows, including group health, workers’ compensation, automobile, and other common insurances.
- Provides expert coding analysis to discover upcoding used to inflate billed charges.
- Identify and respond to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.
- Conduct ongoing research and make mandated phone calls as necessary.
- Utilize current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature for decision-making.
- Ensure providers follow all acceptable coding practices.
- Utilizes company resources to attend trainings, seminars, and other continuous development activities.
- Acts as a central resource to the team for guidance regarding medical billing questions.
- Maintains punctual, regular, and predictable attendance.
- Works collaboratively in a team environment with a spirit of cooperation.
- Other duties & special projects, as assigned and based on business needs.
Qualifications
- Doctoral Degree in Medicine (MD) and seven to ten years’ experience and/or training as a physician or surgeon.
- Strong desire to learn a new side of medicine and engage in a transformative company.
- Ability to perform essential duties with or without reasonable accommodation and without posing a direct threat to the safety or health of employees or others.
- Knowledge of URAC and relevant State and Federal compliance guidelines is recommended but not required.
- Strong attention to detail with excellent verbal and written communication skills.
- Proficient in MS Office suite (Excel, Word, Outlook).
- Ability to use and learn various computer applications (e.g., internal bill review software).
- Good interpersonal and organizational skills.
- Ability to meet deadlines, work independently, and manage time effectively.
- Highly self-motivated and able to partner effectively with cross-functional teams to achieve desired business results.
- Experience in medical billing, claims review, or utilization management is preferred.
Location: Hybrid
Classification: Hourly, Non-Exempt
Status: Part-time, Regular
Salary range: $100-150 per hour
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