Research Medical Director (Medicaid Medical Policy)
New
Can work remotely in the USFull-TimeDirector
Salary$225,000 to $275,000 per year
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Job Details
- Experience
- 10+ years of Research experience
- Required Skills
- Project ManagementData analytics
Requirements
- United States MD or DO degree required.
- MBA degree preferred.
- 10+ years of research experience.
- Experience working with a Medicaid payer preferred.
- Knowledge of healthcare payers, policy payment, and correct coding.
- In-depth knowledge of claims, claims adjudication, and medical policy rules.
- Proven success as a manager in a scalable organization.
- Strong organizational and project management experience.
- Excellent written and verbal communication skills.
- Ability to work in a matrix environment.
Responsibilities
- Interpret and assess payment policy and medical coding information against the policy library.
- Conduct thorough research and analysis for medical policy items.
- Perform multi-faceted analytics for data and report analysis.
- Translate industry references into company policy.
- Identify and implement updates to medical policies to ensure accuracy.
- Perform quality assurance (QA) on policy reviews, logic revisions, and research requests.
- Educate client-facing MDs and Client Policy Managers on policy updates.
- Manage and mentor other MDs and administrative staff.
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