Medical Director

We are looking to add an experienced Medical Director to our team of talented professionals.

What you'll do:

The Comprehensive Error Rate Testing (CERT) Contractor Medical Directors (CMDs) will provide leadership in the provider community, including:

Interacting with medical societies and peer groups.
• Educating providers, individually or as a group, regarding identified problems or LCDs.
• Serving as a readily available source of medical information to provide guidance in questionable claims review situations.
• Briefing and directing personnel on the correct application of policy during claim adjudication, including through written internal claim review guidelines.
• Keeping abreast of medical practice and technology changes that may result in improper billing or program abuse.
• Providing the clinical expertise and judgment to effectively focus MR on areas of potential fraud and abuse.
• Serving as a readily available source of medical information to provide guidance in questionable situations.
• Interacting with the CMDs at other contractors to share information on potential problem areas
• Participating in CMD clinical workgroups, as appropriate.
• Providing input to CO on national coverage and payment policy, including recommendations for relative value unit (RVU) assignments.
• Telework available from the contiguous United States

Required Qualifications:

• Education and Licensure:
• Doctor of Medicine or Doctor of Osteopathy Degree
• Current licensure to practice medicine
• A minimum opf 16 years of experience in health care industry and or management experience
• A minimum of three years of experience practicing medicine as a board-certified physician with no previous sanctioning or exclusion from the Medicare program
• Experience in the health insurance industry, a utilization review firm, or another 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
• Public relations experience such as working with physician groups, beneficiary organizations, and/or congressional offices
• US Citizenship is required.

Basic Qualifications:

• Expert representational, oral, and written communication skills
• Superior organizational and interpersonal skills and demonstrated ability to interface effectively via written and oral forums with personnel at all levels of government
• Expert skills using MS Office Suite, including Outlook, Word, Excel, and PowerPoint
• Ability to effectively work independently and as a member of a team
• Previous experience with CERT program preferred

* The position is contingent pending contract award.*

Peraton is a next-generation national security company that drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world's leading mission capability integrator and transformative enterprise IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies. Peraton operates at the critical nexus between traditional and nontraditional threats across all domains: land, sea, space, air, and cyberspace. The company serves as a valued partner to essential government agencies and supports every branch of the U.S. armed forces. Each day, our employees do the can't be done by solving the most daunting challenges facing our customers. Visit peraton.com to learn how we're keeping people around the world safe and secure.