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Job Details

Requisition Number 18-1241
Title Medical Director
City Remote (work from home w/travel)
State US


The Medical Director is a key member of the client team and represents the team on all Medical Policy decisions as well as directing the Medical Policy Committee-(which is composed of Medical Directors, Coding Analysts, and Provider Relations.) The Medical Director is also responsible for interpreting and assessing payment policy for clients and provides consultation and policy advice. The Medical Director will guide both internal and external processes as related to policy assessment and interpretation.

Primary Responsibilities

  • Presents payment policy to clients for selection.
  • Works with Medical Policy team, helping them to evaluate and validate the editing.
  • Directing the research & development efforts of our Medical Policy team.
  • Acts as a clinical liaison with our health plan clients
  • Supporting new sales activity and existing client growth by identifying value creation opportunities for our clients
  • In depth knowledge of claims, claims adjudication, medical policy rules and edits
  • Builds value and credibility with clients
  • Inspires trust and credibility- delivers on commitments, MD subject matter expert.
  • New client implementations as needed
  • Completes client requests for research and inquiries in a timely manner
  • Defines mission and strategy with CSVP; delivers strategy to clients medical policy team.
  • Supports Sales process for new and existing clients
  • Creating capability and results presentations and claims analysis

Other Related Responsibilities

  • Drives and supports the vision and values of Cotiviti Healthcare and abides by all policies and procedures.
  • Improves and implements procedures as needed and/or assigned.
  • Consistently provides optimum service to all internal and external customers.
  • Consistently works to develop and maintain positive and professional relationships with all internal and external customers.

Must have:

  • Degree in Medicine (MD or DO) – active or in-active license
  • Professional certification (CPC, CPC-H, CPC-P or CCS-P) or willingness to attend coding boot camp sponsored by the Company
  • Minimum of 5 years of experience in a clinical setting
  • Minimum of 3 years of experience in internet based research as it relates to codes (CPT, HCPCS, ICD, etc.)
  • Experience in a health plan, Medicare or State Medicaid with focus on reimbursement and/or coding preferred (CPT, ICD-10, etc.). Equivalent experience would be knowledge through a payer services organization working with one or more of the organizations noted above.

What we’re looking for:

  • Experience in private sector/ Health plan operations as a Medical Director, with focus on reimbursement, medical coding (CPT, ICD-10).
  • Consulting experience within a healthcare coding and reimbursement company is a definite plus.
  • Strong analytical and problem solving skills
  • Excel proficiency preferred
  • Strong organizational skills and adaptive capacity for rapidly changing priorities and workloads
  • Professional with ability to properly handle confidential information
  • Ability to work well independently and in a team environment.
  • Ability to handle multiple tasks, prioritize and meet deadlines.
  • Excellent written and verbal communication skills.

Job Demands

  • Must be able to sit and use a computer keyboard for extended periods of time
  • Moderate travel required up to 20 percent of time
  • Heavy initial travel associated with training
  • Must be able to lift up to 20 lbs without assistance
  • Must have ability to positively handle/manage stress, such as high work volume and frequent change
  • After hours and/or weekend work required where necessary for major deliverables/deadlines (not consistent)
  • We are an Equal Opportunity Employer.
  • Please view Equal Employment Opportunity Posters provided by OFCCP here.

  • Cotiviti is an Equal Opportunity Employer. The Company provides equal employment opportunities to all applicants for employment without regard to gender, sexual orientation or preference, gender identity or expression, race, color, religion, national origin, ethnicity, ancestry, age, marital status, pregnancy, childbirth or related medical conditions, mental or physical disability, veteran status or any other characteristic protected by federal, state or local law, ordinance or regulation.

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