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Clinical Compliance Medical Director - Remote or Office Based

Company: Anthem Inc.
Location: Fresno
Posted on: May 14, 2020

Job Description:

Responsible for providing clinical guidance related to the company's coding guidelines, provider coding audits, and participates in developing an investigation team that focuses on potential fraud, waste and abuse in the provider population.Primary duties may include, but are not limited to:Reviews provider medical record documentation to determine if there is potential fraud, waste, or abuse that warrants further investigations.Conducts provider interviews related to these investigations.Reviews investigative material which includes provider medical record documentation.Provides clinical guidance regarding coding guidelines and develops provider educational material.Provide input and assist with developing a more clinically focused provider audit process to obtain more meaningful results.Develops clinical review for investigations team including developing guidelines on how to implement the clinical analysis portion of the investigations and developing clinically relevant questions for provider interviews.Develops provider educational materials that are clinically focused and provides peer-to-peer compliance training and education to other providers internally and externally.Provides input to provider reporting from the provider perspective.An Equal Opportunity Employer/Disability/VeteranQualificationsM.D. or D.O.; Board certification approved by the American Board of Medical Specialties required where applicable to duties being performed.Requires active unrestricted medical license to practice medicine or a health profession.Clinical training and practice as a primary care physician required.5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.Medicare Risk Adjustment preferredMedical coding certification (AAPC or AHIMA) preferred.

Keywords: Anthem Inc., Fresno , Clinical Compliance Medical Director - Remote or Office Based, Administration, Clerical , Fresno, California

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