WhitePlainsRecruiter Since 2001
the smart solution for White Plains jobs

Senior Administrative Medical Director Focused Claims Review (858158)

Company: MedExpress
Location: White Plains
Posted on: September 12, 2020

Job Description:

Senior Administrative Medical Director Focused Claims Review (858158)

M Senior Administrative Medical Director Focused Claims Review (858158) Description

Position Description

OrthoNet is a proud member of the UnitedHeath Group family of companies and a leading orthopedic specialty benefit management company. OrthoNet works with more than 80,000 orthopedic health care providers, including specialists in orthopedic surgery, neurosurgery, podiatry, and physical, occupational, and speech therapy. Our mission is to achieve optimal outcomes for payors, providers, and members in a manner that combines efficient delivery of services, high quality care, and state of the art utilization and cost management tools. Join our team and together we can ensure the delivery of high quality, cost-effective care for our members and customers.

As an important member of the FCR leadership team, the Senior Administrative Medical Director, reporting to the VP/Product Leader, will lead highly skilled multi-specialty Medical Director teams in the detailed comparative analysis of claims accuracy vs medical record notes. This is a unique opportunity to drive FCR forward by collaborating with Operations Leadership forming a cohesive team focused on providing innovative solutions and strategies, strong leadership and high quality results for all aspects of the clinical/coding review within the FCR product suite of payment integrity programs and services ring The Medical Director is expected to represent the programs he/she work on internally and to clients as needed, including during the sales and customer services activities.

Primary Responsibilities:

Payment Integrity

Lead multi-specialty physician teams for OrthoNet's growing family of payment integrity (Focused Claims Review) programs.

Oversee tactical execution of reviews ensuring all activities are completed within contractual guidelines including quality measures, turn-around-times and volume metrics

Oversee and develop claim guidelines continuing education and code updates, ensuring all MD results are consistent with high accuracy and detail

Expertise with professional procedure coding, claim reviews and appeal activity. Skilled at providing explanations of adverse decisions made on claims.

Strong interest in fraud and abuse detection and prevention

Committee and Administrative Leadership Responsibilities

Coordinate daily schedules of staff and consultant MDs ensuring a continuum of coverage for each specialty

Ensure high quality peer-to-peer coverage and content of discussions. Coordinate on-call schedules , aids in recruitment and professional development as appropriate

Manage day-to-day operations. Review and approve all staff out of office requests including vacation, CME, illness, LOA, etc. Perform annual quality and administrative staff reviews as required

Perform quality and quantity reviews, ensuring high quality performance and achievement of corporate goals

Serve on various internal and/or external Committees and in other such capacities as necessary

Liaison Activities

Assists with liaison relationships with payors and providers in the community as needed with regard to Payment Integrity

Serves as Lead contact with participating providers regarding payment integrity services and/or issues with OrthoNet MD activities. Supports other OrthoNet medical directors and staff within broader client base as needed as a professional, regulatory and community liaison

Regulatory Requirements

Supports compliance with regulatory agency standards and requirements (i.e. HCFA, NCQA, URAC, state/federal and third party payors)

Perform all other duties as assigned.

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

M.D. or D.O. degree

Current and active Unrestricted, Medical license(s) in US state(s)

Board certification required in ABMS-recognized specialty

Minimum of 5 years' post-graduate experience in clinical medical practice/patient care

Minimum of 2 years' experience managing professional staff and leading teams of physicians

Minimum of 2 years' experience in a managed care environment; to include coding and quality improvement experience

Must possess leadership skills in working with other physicians and non-physicians, knowledge of the overall medical community and the local/regional managed care environments

Experience with integration of clinical and financial data, development of utilization and performance reporting tools, and communication of performance data to physicians and other health care providers.

Strong abilities and experience in large size health care organizations that are geographically widely distributed and heavily virtual ("remote workers")

Demonstrated ability in developing and internally marketing concepts for program improvement and program development.

Ability and experience in relating to individuals at many levels of large organizations.

Experience in presenting/selling programs to potential clients.

Specific familiarity with managed care accreditation activities and NCQA, URAC, CMS, state and other federal regulations.

MS Office (MS Word, Excel, and Power Point)

Preferred Qualifications:

Certifications: ABMS specialty preferably with musculoskeletal/orthopedic emphasis

MBA

Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work.(sm)

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: Medical Director, Claims, ABMS, M.D., D.O., coding, quality improvement

Job Details

Associated topics: care, care physician, clinic, family medicine physician, family practice physician, hospitalist, nocturnist, physician md, practice physician, primary care

Job Information

Job ID: ba5122c0-12126671581

Location:

White Plains, New York, United States

Jobs You May Like Program Officer, Criminal Justice Grantmaking

Charles and Lynn Schusterman...

New York, NY, United States

FF

Special Assistant

Ford Foundation

New York, NY, United States

B

Associate, Portfolio Strategy and Management,...

Blue Meridian Partners

New York, NY, United States

B

Senior Associate, Portfolio Strategy and...

Keywords: MedExpress, White Plains , Senior Administrative Medical Director Focused Claims Review (858158), Other , White Plains, New York

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Other Jobs


Amazon Workforce Staffing: Amazon Shopper
Description: Shifts: Overnight, Early Morning, Day, Evening, WeekendLocation:Trumbull, CTStratford, CTFairfield, CTMilford, CTJob opportunities vary by location. We update postings daily with open positions.Hourly (more...)
Company: Amazon Workforce Staffing
Location: Westport
Posted on: 09/28/2020

Whole Foods Shopper - Fairfield
Description: Job DescriptionShifts: Overnight, Early Morning, Day, Evening, Weekend Location: Trumbull, CT Stratford, CT Fairfield, CT Milford, CT Job opportunities vary by location. We update postings daily with (more...)
Company: Amazon Workforce Staffing
Location: Westport
Posted on: 09/28/2020

Amazon Workforce Staffing: Whole Foods Shopper --- Milford
Description: Shifts: Overnight, Early Morning, Day, Evening, WeekendLocation:Trumbull, CTStratford, CTFairfield, CTMilford, CTJob opportunities vary by location. We update postings daily with open positions.Hourly (more...)
Company: Amazon Workforce Staffing
Location: Westport
Posted on: 09/28/2020


Delivery Driver - Flexible Schedule
Description: Job DescriptionDeliver with Uber. Earn on your schedule. Work on your schedule. Deliver for a few hours in the mornings, every night, or just on weekends--it's up to you. Earn Good Money. You'll
Company: Uber Eats
Location: Westport
Posted on: 09/28/2020

Order Picker/Packer - Immediate Hire (Milford)
Description: Job DescriptionShifts: Overnight, Early Morning, Day, Evening, Weekend Location: Trumbull, CT Stratford, CT Fairfield, CT Milford, CT Job opportunities vary by location. We update postings daily with (more...)
Company: Amazon Workforce Staffing
Location: Westport
Posted on: 09/28/2020

Amazon Order Filler - Immediate Hire (North Haven)
Description: Job DescriptionShifts: Overnight, Early Morning, Day, Evening, Weekend Location: North Haven, CT Job opportunities vary by location. We update postings daily with open positions. Hourly pay rate: Earn (more...)
Company: Amazon Workforce Staffing
Location: Westport
Posted on: 09/28/2020

Amazon Shopper
Description: Job DescriptionShifts: Overnight, Early Morning, Day, Evening, Weekend Location: Trumbull, CT Stratford, CT Fairfield, CT Milford, CT Job opportunities vary by location. We update postings daily with (more...)
Company: Amazon Workforce Staffing
Location: Westport
Posted on: 09/28/2020

Whole Foods Order Picker/Packer - Fairfield
Description: Job DescriptionShifts: Overnight, Early Morning, Day, Evening, Weekend Location: Trumbull, CT Stratford, CT Fairfield, CT Milford, CT Job opportunities vary by location. We update postings daily with (more...)
Company: Amazon Workforce Staffing
Location: Westport
Posted on: 09/28/2020

Amazon Order Filler - Full-time Overnight Shifts Available
Description: Job DescriptionShifts: Overnight, Early Morning, Day, Evening, Weekend Location: Trumbull, CT Stratford, CT Fairfield, CT Milford, CT Job opportunities vary by location. We update postings daily with (more...)
Company: Amazon Workforce Staffing
Location: Westport
Posted on: 09/28/2020

Whole Foods Order Picker/Packer - Milford
Description: Job DescriptionShifts: Overnight, Early Morning, Day, Evening, Weekend Location: Trumbull, CT Stratford, CT Fairfield, CT Milford, CT Job opportunities vary by location. We update postings daily with (more...)
Company: Amazon Workforce Staffing
Location: Westport
Posted on: 09/28/2020

Log In or Create An Account

Get the latest New York jobs by following @recnetNY on Twitter!

White Plains RSS job feeds