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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive knowledge of Medicare and Medicaid policies, clinical documentation interpretation, and coding practices. Provides clinical guidance and training while serving as a subject matter expert in healthcare compliance and claims processing.
Highest-signal resume keywords
Doctor Of Medicine DegreeBoard Certified PhysicianMedicare And Medicaid KnowledgeClinical Documentation InterpretationCoding Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical GuidanceFraud PreventionHCPCS/CPT Code InterpretationCoding PoliciesHealth Care Research
Soft Skills
Strong Communication SkillsCollaboration Ability
Certifications & Qualifications
Active Medical LicenseBoard Certification
Industry Keywords
Health Insurance IndustryUtilization ReviewCompliance Responsibilities
About the role
Key responsibilities & impact- Represent RELI Group and its partners across federal contracts
- Contribute to fraud prevention
- Provide clinical guidance for coders
- Answer questions and resolve complex medical record issues during contract performance
- Participate in work group meetings and provide clinical input and guidance
- Serve as a clinical subject matter expert
- Attend and participate in all contractor meetings
- Conduct research to provide input and support across contracts
- Prepare research documents to support educational materials
- Provide clinical and coding training to contract staff as needed
Requirements
What you’ll need- Graduate Degree
- Doctor of Medicine or Doctor of Osteopathy Degree
- Current active, valid, and unrestricted license to practice medicine in at least one US state
- No previous sanctioning or exclusion from the Medicare program
- Board certified for at least 3 years as a physician in a specialty recognized by the American Board of Medical Specialties
- Three years’ experience practicing medicine as a board-certified physician
- Extensive knowledge of Medicare and Medicaid payment, coverage, and coding policies
- Ability to interpret clinical documentation and resolve disagreements regarding clinical guidelines
- Experience in the health insurance industry, a utilization review firm, or another health care claims processing organization in a role involving compliance responsibilities
- Experience interpreting HCPCS/CPT codes and coding conventions
- Advanced knowledge of health care and health care research
- Ability to collaborate with all levels within the contract
- Strong written and verbal communication skills
- Coding experience/certification preferred
Benefits
Comp & perks- Additional benefits provided by RELI Group
- Equal Employment Opportunity / Affirmative Action employer
- HUBZone candidates are encouraged to apply