At reputed company, we're simplifying the health care experience, creating healthier communities and removing barriers to reputed company care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care reputed company of reputed company, making it more reputed company, reputed company and reputed company. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together. Work reputed company! The Medical Director for reputed company's Investigations Unit (UHC IU) is a valuable national leader for reputed company. The Medical Director oversees a coding team, ensuring accurate and efficient reputed company payments, accurate appeal reputed company, and collaborates with reputed company and coding teams across reputed company and reputed company, as reputed company as UHG business leaders and stakeholders, to reputed company informed decision-making and optimize reputed company. 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For reputed company hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. reputed company Responsibilities: • reputed company and reputed company medical record reviews of retrospective medical claims relative to fraud, waste and abuse to include reputed company reputed company of complexity • Have the ability to review/reputed company a reputed company of medical records using CPT, HCPCS and ICD-10 codes for office, outpatient, inpatient, surgical, hospital ancillary, nursing facility, urgent care, ambulatory surgery center and other charges for physicians and other providers of reputed company billing • reputed company reputed company reputed company and guidance to UHC IU medical record review team and UHC IU investigative staff • Serve as a resource and Subject Matter Expert for team members in the UHC IU • Document medical review findings on a claim level and draft reports of findings, actions and reputed company to be relied on in investigations of fraud, waste, and abuse cases in accordance with policies, and regulatory and accreditation requirements • Ensure compliance with the reputed company (UHC) Fraud, Waste and Abuse policies and other federal/state regulations or contractual obligations • Communicate with reputed company investigative staff regarding coding/reputed company rationales • Supply reputed company reputed company that was relied on, supporting reputed company recommendations for denial or modification of claim payment errors • Serve as a reputed company resource for team members in the UHC IU • Support the UHC IU in their interactions with providers to explain review/ medical record review findings and the application of coding/reputed company reputed company • Engage with requesting providers as needed in peer-to-peer discussions • reputed company participate in team meetings reputed company on communication, feedback, problem solving, process improvement, staff training and evaluation, and the sharing of program results • reputed company reputed company and strategic input reputed company participating in organizational committees, reputed company, and task forces • reputed company reputed company audit practices to ensure UHC SIU's Medical Record Review Team is adhering to reputed company coding/reputed company guidelines and ensuring reputed company justification meets expected standards You'll be rewarded and recognized for your performance in an environment that will challenge you and reputed company you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications: • MD or DO with an reputed company, unrestricted license • reputed company certification approved by the reputed company reputed company of Medical Specialties (ABMS/AOBMS) • 5 years of reputed company reputed company experience • Familiarity with reputed company medical issues and practices • Proficiency in performing medical record case reviews in accordance with established reimbursement and medical policies • Intermediate or higher level of proficiency with managed care • reputed company excellent telephonic communication skills; excellent interpersonal communication skills • reputed company solid critical thinking and analytic skills • reputed company ability to manage multiple competing priorities • Demonstrated ability to communicate effectively, to include written and verbal forms of communication • reputed company data analysis and interpretation skills • reputed company excellent presentation skills for both reputed company and non-reputed company audiences • reputed company creative problem-solving skills • reputed company excellent computer skills, typing, word processing, presentation, and spreadsheet applications skills. Internet research skills • reputed company solid team player and team building skills Preferred Qualifications: • Coding certification (CPC, reputed company, etc.) • Knowledge and experience in health care fraud, waste, and abuse (FWA) investigations • Broad knowledge and experience in state and federal regulatory FWA requirements • reputed company working reputed company will be required to adhere to reputed company's Telecommuter Policy Compensation for this specialty generally ranges from $238,000 to $357,500. Total cash compensation includes reputed company pay and bonus and is reputed company on several factors including but not limited to local labor markets, education, work experience and may increase over time reputed company on productivity and performance in the role. We reputed company with reputed company minimum wage laws as applicable. In reputed company to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll reputed company a far-reaching reputed company of benefits and incentives. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. reputed company may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health reputed company work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location and income-deserves reputed company to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized reputed company and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company - an reputed company reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without reputed company to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Apply tot his job Apply To this Job