Director of Medical Review at Capitol Bridge LLC in Washington, DC

For over 21 years, TDB Communications, Inc. has placed over thousands of employees in various positions across the United States. We are looking for a Director of Medical Review for our client Capitol Bridge, LLC.

The Director of Medical Review is a key member of our Medical Management and Operations staff within the Capitol Bridge portfolio.

As the Director of Medical Review, this position will be looked to as an expert on variety of clinical areas.

This position will be limited in scope at the outset, being primarily dedicated to the National Correct Coding Initiative (NCCI) program. As it relates to the NCCI program, the Director will need to provide expert guidance regarding coding matters and be able to review and improve proposed changes. They will work in conjunction with the NCCI program director on decision making, coding and medical understanding, and policy expertise.

However, the Capitol Bridge team is focused on the long-term growth and continuous improvement of our clinical efforts. Therefore, it is critical that the Director of Medical Review demonstrate an ability to be flexible with a focus on driving continuous improvement within our organization. Additionally, the Director of Medical Review will be tasked with aligning and ensuring compliance of programs within their portfolio to stated quality metrics as defined within each individual contract.

General Responsibilities

• Ability to work effectively in a “hands-on” management role, motivating staff through a variety of communications vehicles.
• Direct and control the activities of a broad functional area through several department managers within the company.
• Provide consultation as needed to clinical review teams regarding complex deliverables and cases.
• Provide advice and counsel to the clients as per leadership directive.
• Drive innovative solutions to include automation to ensure cutting edge strategies & implementation of best practices within our industry
• Manage client relationships with all relevant client staff, including the program and contract teams
• Ensure deliverables meet clinical quality requirements as defined within assigned programs.
• Assist program staff in consistent interpretation of all relevant federal and state-specific criteria and guidelines.
• Year round Edit Development decisions and documentation for CPT, HCPCS, PLA, and other related codes.
• Review Medicare correct coding decisions and determine the applicability to Medicaid program, elevating the decisions to a separate call when necessary.
• Evaluate State Medicaid Agency requests to deactivate or change edits.
• Assist the correspondence team in developing medically appropriate responses to inquiries.
• Provide expert analysis and review of manuals throughout the project life cycle.
• Monitor and evaluate policy changes impacting the NCCI program
• Board Certified Physician with license to practice in the United States
• Knowledge and understanding of Correct Coding Principals
• Experience managing remote teams with mixed professional disciplines (medical policy, clinical practice, information technology, etc.)
• Experience presenting findings, recommendations, and leading ensuing discussion
• Experience navigating complex stakeholder scenarios. Interactions frequently involve special skills, such as negotiating with customers or management or attempting to influence senior level leaders regarding matters of significance to the organization.
• Knowledge of the CMS related policy guidance specific to CMS and its contractors

NCCI Responsibilities

Requirements

Physical Requirements and Work Environment

• All employees are required to wear a mask when they are in community with other employees
• (as recommended by CDC guidelines)
• Prolonged sitting throughout the workday with occasional mobility required.
• Corrected vision within the normal range.
• Hearing within normal range. A device to enhance hearing may be provided if needed.
• Must possess sufficient manual dexterity to skillfully operate an on-line computer terminal and other standard office equipment, including a financial calculator, personal computer, and telephone.
• Occasional movements throughout the department daily to interact with staff, accomplish tasks, etc.

Screenings Requested

You may receive requests for background check and or drug screen regarding this employment opportunity. Respond to all requests quickly as we anticipate filling our vacancies quickly and non-responses may result in disqualification for this opportunity.

Reasonable Accommodation

If you require alternative methods of application or screening, you must approach the employer directly to request this.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.

EEO Statement

TDB Communications, Inc. is an Equal Opportunity Employer. All employment decisions at TDB are based on business needs, job requirements and individual qualifications, without regard to race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate

Federal Contractor and E-Verify compliant.