JOB TITLE: Medical Director
LOCATION: US Remote or Onsite Location: WB PA.
REPORTS TO: Chief Operation Officer
Requisition Number: 20210426.02CMD
About Engage Health:
Engage is a fast-growing, innovative company focused on providing solutions for both public and private entities which improve payment accuracy in the healthcare industry. Engage Health provides technological and consultative solutions that meet the dynamic demands of the healthcare industry. We utilize sophisticated analytics to identify & correct irregularities in medical coding and billing which allows clients to enjoy improved financial performance.
Since our inception in 2016, Engage Health Solutions has excelled in the healthcare space. We are seeking to add to our healthcare team to enhance our company. The culture of the company is entrepreneurial, hardworking, and respectful of the work/life balance. We believe in, and reward, individuals who are motivated, accountable and work diligently to meet our collective goals.
The Medical Director (MD) is responsible to plan, develop and direct the Company’s medical policies, procedures and strategies, as well as provide oversight to the review team. The Medical Director will also serve as the Company’s liaison for external interactions, including communication with the Company’s clients, and other third parties.
As a MD, you will be part of a team of experienced clinicians and certified coders performing pre & post bill policy review on Medical claims. You will work in a fast paced and dynamic environment and provide guidance to the clinical team. The successful candidate will be a strong leader as well as a team player able to collaborate with a variety of different entities to solve problems and generate solutions. The position is responsible for creating policies and implementing procedures that ensure efficient, smooth and prompt health services resulting in positive outcomes for the patient.
- Identifies and develops revenue cycle and payment integrity issues by working collaboratively with ENGAGE team and clients to identify vulnerabilities and/or cases
- Provides and / or has oversight responsibility for clinical staff development, internal training, and external facing training programs
- Plans and directs the organization’s medical policies, programs, and strategies, including implementation
- Provide oversight of review staff
- Serves as liaison to client
- Responsible for strategic relationships with physicians, nurses, and clients
- In a limited role, perform review of medical documentation, perform quality review function and research of issues, policy changes and updates
- Ensures all clinical programs are in compliance with regulations and contracts
- Participating in planning activities and managing subsequent execution in attainment of performance targets
- Works with the interdisciplinary team to ensure quality, implement appropriate policies, procedures, and programs.
- Oversees the development of the clinical content in marketing materials
- Assists and participates in the business development team by creating external facing content for advertising, social media, website content, participating in webinars, podcasts, and client calls.
- Relies on experience and judgment to plan and accomplish goals
- Travel may be required
- Active unrestricted MD license (graduate level degree or higher in good standing with 5+ years of clinical experience)
- Prior Medical Director experience for an insurance company, Tricare, MAC, or organizations performing similar functions
- Fluency with utilization management systems or clinical decision-making tools such as Medical Coverage Guidelines (MCG) or InterQual experience with ICD-10, CPT or HCPCS coding.
- Knowledge of the Medicare program and medical reimbursement policy particularly the coverage and payment rules.
- Ability to maintain high quality work while meeting strict deadlines.
- Excellent analytical, written and verbal communication skills.
- Not currently sanctioned or excluded from the Medicare program by the OIG.
- Ability to work independently as well as in a team environment.
- Strong knowledge of medical documentation.
- Courteous, professional, and respectful attitude.
- Flexibility to handle any non-standard situations that may arise.
- Proficient on PC and related software programs
- Sit/stand/ walk/8-10hr/day
- Lift/carry/push/pull under and over 10lbs occasionally
- Keying frequency, handling, reaching, fine manipulation
Engage offers a full compensation and benefits package that includes:
- Competitive salary
- Health insurance including vision and dental
- 401K, Short/Long Term Disability, Life Insurance
- Paid time off and holidays