Medical Director

DescriptionAbout Us:

At RELI Group, our work is grounded in purpose. We partner with government agencies to solve complex challenges, improve public health, strengthen national security, and make government services more effective and efficient. Our team of over 500 professionals brings deep expertise and a shared commitment to delivering meaningful outcomes. Behind every solution is a group of experts who care deeply about impact-whether we're supporting data-driven decisions, modernizing systems or safeguarding critical programs. As Medical Director you will be responsible for representing Reli Group and it's partners across federal contracts. You will be responsible for contributing to fraud prevention through making and editing PTP, MUE and AOC edits, supporting the NCCI contract, providing clinical guidance for coders, and helping answer questions and resolve complex medical record issues that may arise during the performance of the contracts.

Responsibilities:

Participate in the production of NCCI Procedure to Procedure edits, Medically Unlikely Edits, and Add-on code file editsParticipate in work group meetings to provide clinical input and guidance Serve as a clinical subject matter expert to resolve complex medical record issueAttend and participate in all contractor meetingsMust have strong written and verbal communication skillsConduct research to provide input and support across contractPrepare research documents to support educational materialsProvide clinical and coding training to contract staff as neededQualificationsExtensive knowledge of Medicare and Medicaid payment, coverage, and coding policies; Interpreting clinical documentation and capable of effectively interpreting and resolving disagreements regarding clinical guidelines.

Doctor of Medicine or Doctor of Osteopathy DegreeCurrent active, valid, and unrestricted license practice medicine in at least one US state with no previous sanctioning or exclusion from the Medicare programBoard certified for at least 3 years as a physician in a specialty recognized by the American Board of Medical SpecialtiesThree years' experience practicing medicine as a board-certified physician Experience in the health insurance industry, a utilization review firm, or another health care claims processing organization in a role that involved compliance responsibilitiesExperience in interpreting

HCPCS/CPT

codes and coding conventionsExtensive knowledge of Medicare and Medicaid payment, coverage and coding policiesAdvanced knowledge of health care and health care researchAbility to collaborate with all levels within the contractCoding experience/certification (preferred)

EEO Employer:

RELI Group is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

HUBZone:

We encourage all candidates who live in a HUBZone to apply. You can check to see if your address is located in a HUBZone by accessing the SBA HUBZone Map. The annual salary range for this position is $240,000 to $280,000. Actual compensation will depend on a range of factors, ...For full information see follow application link. RELI Group is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.