Medical Director, Denials Management
New
United States, Monday-Friday, 8a-5p ET to 10a-7p ETFull-TimeManager
SalaryUSD 225000 - 225000 / year (includes salary + uncapped bonus)
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Job Details
- Experience
- At a minimum, 1 year of acute care adult hospital experience in a US hospital within the past 5 years or recent relevant physician advisor experience
Requirements
- MD or DO degree.
- Active unrestricted medical license in at least one US state.
- Required specialization in Adult Internal Medicine, Emergency Medicine, Hospitalist, Nephrology, HEM/ONC, General Surgery, Family Practice, Critical Care, or Infectious Disease.
- At minimum 1 year of acute care adult hospital experience in a US hospital within the past 5 years or recent relevant physician advisor experience.
- Working knowledge of hospital EMR platforms.
- Computer proficiency and ability to learn new technology quickly.
- Strong verbal and written communication skills.
- Board certification (preferred).
Responsibilities
- Evaluate hospitalizations and perform clinical case reviews to establish appropriate admission status.
- Conduct peer-to-peer case discussions with payer medical directors.
- Utilize clinical expertise to identify salient points within case reviews.
- Perform focused real-time and post-discharge hospital case reviews in client EMR systems.
- Identify areas of process improvement and inefficiencies.
- Provide recommendations to hospital clients to improve compliance and ensure appropriate payment.
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