Medical Director

5 days ago

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Empower AI

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Empower AI helps federal agency leaders elevate their workforce productivity. We leverage deep technical expertise and decades of experience solving complex challenges in Civilian and Defense missions to ensure America’s missions are met. Our solutions give government leaders a direct path to meaningful transformation, equipping them with the insights and tools necessary to make critical decisions faster and move their missions forward.

Artificial Intelligence • Agile • DevSecOps • Big Data • Cypersecurity

501 - 1000 employees

Founded 1989

📋 Description

• Responsible for medical insight and expertise for Medicare claims review determinations. • Serves as a public spokesperson for the CERT RC contract and the CERT program. • Interacts with medical societies, peer groups, CMS Contractors and/or stakeholders. • Assists in development of contractor policy and updating of policies. • Provides medical insight for claims reviews by specialty physicians. • Makes claims determinations utilizing guidelines and CMS policy. • Collaborates with CERT management on national coverage and payment issues. • Maintains compliance with CMS procedures and guidelines. • Coordinates medical specialty educational sessions when requested. • Communicates effectively with customers, stakeholders, and employees.

🎯 Requirements

• Board-certified doctor of medicine or doctor of osteopathy currently licensed and has practiced medicine for at least four years. • No adverse actions pending or taken against him/her by the Medicare, Medicaid, or any other Federal or State programs, any other medical insurance program, or medical licensing board. • Extensive knowledge of the Medicare program, particularly the coverage and payment rules of the Medicare program. • Does not hold office in any association (medical or specialty society) that promotes the interest of medical or specialty society’s participation in the Medicare program. • Excellent organization, communication/collaboration and decision-making skills. • Ability to work with others in a team environment. • Ability to work with computer programs including MS Word, Excel, Sharepoint and Web-based meeting applications. • Prior work experience in the health insurance industry, utilization review firm, or other health care claims processing organization in a role that involved developing coverage or medical necessity policies and guidelines. • Public relations experience such as working with physician groups, beneficiary organization and/or congressional offices.