[Hiring] Research Medical Director @Cotiviti

Role Description

The Research Medical Director is a key member of the Clinical and Policy research development area at Cotiviti. This role is responsible for providing leadership guidance to the clinical teams and ensuring the Rules and policies are accurately interpreted and developed. The Medical Director will guide both internal and external processes related to Payment Policy Management policies and rules.

This is a full-time role and can work remotely in the US.

• Interpret and assess payment policy and medical coding information/guidelines against our policy library for maintenance of existing policy and development of new policy.
• Conduct thorough research and analysis for medical policy items.
• Perform multi-faceted analytics for data and report analysis.
• Translate industry references into Cotiviti policy.
• Review and identify changes to medical policies to maintain an accurate and current medical policy library.
• Identify new opportunities from both clinical reference and analytical sources.
• Analyze research inquiries from multiple sources and apply solid clinical judgment to determine potential impact on medical policies.
• Determine if an update to existing policy logic or content is warranted based on changes to industry.
• Perform QA of policy reviews, logic revisions, and research requests to ensure accuracy and provide feedback to the originator as needed.
• Educate client-facing MDs and Client Policy Managers (CPMs) on new changes and policy updates by participating in monthly meetings.
• Ensure work is accurate, complete, and finished in a timely manner, including documentation of notable changes.
• Maintain current knowledge of industry and content, best practices, applications, procedures, and policies.
• Complete all responsibilities outlined in the annual performance review and/or goal setting.
• Complete all special projects and other duties as assigned.
• Must be able to perform duties with or without reasonable accommodation.

Qualifications

• A United States MD or DO degree is required; an MBA degree is preferred.
• 10+ years of Research experience.
• Experience working with a Medicaid payer preferred.
• Knowledge of healthcare payers, policy payment, and correct coding knowledge (preferred).
• In-depth knowledge of claims, claims adjudication, medical policy rules, and edits.
• Strong organizational and project management experience preferred.
• Proven success as a manager in a scalable organization with significant scope, complexity, and breadth.
• Strong personal leadership skills.
• Relationship development skills to forge positive and lasting relationships with key business partners and clients.
• Ability to achieve sustainable results through others, including the development and assignment of other MDs and administrative staff as leaders, mentors, trainers, etc.

Requirements

• Ability to work well independently and in a team environment.
• Ability to handle multiple tasks, prioritize, and meet deadlines.
• Highly organized.
• Excellent written and verbal communication skills, strong listening skills.
• Ability to work in a fast-paced, entrepreneurial environment with a strong bias for deep analysis, timely action, and thorough execution.
• Understanding of and ability to lead and manage in a matrix environment where teamwork is essential.
• Ability to make good decisions that are strategically relevant to the company’s goals and objectives.

Physical Requirements and Working Conditions

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Must be able to provide a dedicated, secure work area.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.

Benefits

• Base compensation ranges from $225,000 to $275,000 per year.
• This role is eligible for discretionary bonus consideration.
• Cotiviti offers a competitive benefits package including medical, dental, vision, disability, and life insurance coverage.
• 401(k) savings plans.
• Paid family leave.
• 9 paid holidays per year.
• 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti.