Medical Director - Medicare Claims and Policy Review Job at Williams Consulting

Salary: Negotiable

Williams Consulting, LLC is seeking a candidate to join our growing team as a Contract Medical Director for an immediate opportunity supporting the Centers for Medicare & Medicaid Services. 

 

Williams Consulting, LLC is an 8a, HUBZone located, and Woman-owned Small Business with Federal, State, Local and Commercial clients. We take great pride in our ability to provide exceptional customer service and we value our employees and recognize their contributions to the success of our clients and our company. We offer competitive salaries and support flexible work locations and scheduling, when possible. We offer competitive benefits including Medical, Vision, and Dental coverage through national plans. We also offer Life, AD&D, Short- & Long-Term Disability Insurance, PTO, and 401k.

 

Description

Williams Consulting, LLC is seeking an experienced Medical Director to manage the delivery of a mission-critical Federal program. The Contract Medical Director will be responsible for providing oversight of all contract QA activities, provide consultation for the  PI (Program Integrity) medical review staff regarding policy, medical necessity, coding issues, and FWA (Fraud, Waste, or Abuse) patterns/trends with a focus on Medicare A &B Caims. 

        

Qualifications

• Doctor of Medicine or Doctor of Osteopathy, currently licensed to practice medicine in the United States.
• Prior work experience with the traditional, Medicare programs, a utilization review firm, and/or a health care claims processing organization in a role that involved developing coverage or medical necessity policies and guidelines.
• Extensive knowledge of the Medicare program, particularly the coverage and payment rules and clinical review judgment experience.
• Public relations experience such as working with physician groups, beneficiary organizations, and/or congressional offices.
• Medical Review lead consulting experience supporting a team of high trained Nurse Reviewers.
• Patient care experience and actively involved in the practice of Medicine.
• Experience working with senior level leadership.
• Strong analytical, problem-solving, and decision-making capabilities.
• Proven ability to meet deadlines and work on multiple projects simultaneously.
• Superior verbal and written communication skills.
• Advanced MS Office (Project, Visio, Word, Excel, PowerPoint, Outlook) skills.
• Able to pass background investigation.

 Preferred Experience/Qualifications

• HUBZone candidates are strongly encouraged to apply.

  

Working Conditions and Requirements

While performing the duties of this job, the employee is regularly required to talk or listen. Standing, sitting, squatting, and other normal office-related physical activities are required. Must be able to sit and read computer screens for extended periods.

Williams Consulting, LLC does not discriminate in employment based on race, color, religion, sex, national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-merit factors.

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