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Medical Director

AMRPA - American Medical Rehab Providers

This is a Full-time position in Sunrise, AK posted June 7, 2021.

Regular Full Time


Performant Financial Corporation (NASDAQ: PFMT) is a leading provider of technology-enabled recovery and related analytics services.

The Company’s services help identify and recover delinquent or defaulted assets and improper payments for various government, healthcare and financial services markets in the United States.

The Company was founded in 1976 and is headquartered in Livermore, California.

The Medical Director will have responsibility for providing medical oversight and leadership for the companys healthcare audit and recovery business for both government (CMS RAC) and commercial clients.

Position could include direct management of medical directors and/or associate medical directors as Performant scales the Healthcare team.

The MD will leverage his/her medical clinical expertise, extensive knowledge in Medicare, Medicaid, and private payer rules and regulation, policies and procedures, business acumen, and industry knowledge to influence decision making and operations in the best interest of the company for our healthcare business and to meet contractual requirements to clients.

Duties and Essential Job Functions
Member of Healthcare leadership team Provides leadership and advice to management and audit staff Regular external interaction with government agencies, customers, vendors and subcontractors Maintain current knowledge of trends and issues in medical practice, technologies and impact on payment integrity Provide expertise and sound judgment on interpretation and application of the Medicare, Medicaid, or private payer rules, regulations, policies and procedures.

Provide medical expertise and actively contribute to decisions for workflow, guidelines and resources to meet contract requirements Identify opportunities for increased efficiencies to processes, systems and tools, leveraging operational reports and analysis Apply strong business acumen to conduct reviews and takes initiative for recommendation and action to mitigate risks Partner with Analytics and Audit Concept Development teams to provide consultative oversight identification of audit concepts to pursue Partner with applicable management to provide guidance in development of process, training and guidelines for conducting medical review and audit, including complex reviews Provide oversight and participation in provider outreach and appeals processes, including but not limited to provider notifications, doc-to-doc discussions, and ALJ hearings.

Build collaborative relationships working with CMS, commercial healthcare providers, as well as internal and subcontracted management and staff associated with the companys medical review and audit business.

Participate in provider, CMS, RAC and external partner meetings Collaborate internally to contribute to building best practices Identification and submission to CMS of major issues/vulnerabilities having significant impact on Medicare Interaction with Medical Directors of other contractors and/or RACs to share information on potential problem areas, participate in presentations to providers or associations, or workgroups as may be required Leverage relational network and insights to payer environments to identify opportunities to expand Performant footprint Support the sales and marketing teams as required providing medical and/or policy expertise Provide expertise and contribute to strategies for presenting appropriately and strengthening the company position within the government and commercial healthcare communities Ensure appropriate skills and specialty experience is represented in the team of regular employees, contractors, or subcontractors to provide required medical oversight to support the diverse client and business needs, in a manner that is in the best interest of the company Provides coaching, feedback and holds accountability for results and behaviors Serves as positive role model and leads by example in alignment with company mission, vision and values Develops implementation strategy, plan and resource requirements for new accounts or project

Required Skills and Knowledge:
Strong working knowledge of the Medicare (Part A, Part B & DME preferred), Medicaid, and private payer rules, regulations, coverage determinations, policies and procedures Significant operating knowledge of CMS and applicable functions of MAC, QIO, RVC, and RA Public relations experience such as working with physician groups, beneficiary organizations or Congressional offices Strong business acumen coupled with analytical and critical thinking abilities Exceptional influencing, facilitation, and interpersonal communication skills one-on-one and in group settings.

Possess ability to work in team environment where collaboration to solve problems, generate solutions and the knowledge transfer process are critical for success.

Ability to build strong relationships both internal and external to the organization Ability to deal well with ambiguity.

Can effectively shift gears comfortably, can decide and act without having the total picture, comfortable handling risk and adversity.

Demonstrates good judgment by anticipating the consequences of actions and weighing multiple, sometimes conflicting, priorities Ability to act with confidence, make good decisions in the best interest of the company and drive results given direction in the form of assigned goals objectives.

Able to solve complex problems, and resolve disagreements with informed, rational debate.

Builds credibility and trust Mind-set of continuous improvement and adapts quickly to change Strong management skills in coaching, mentoring and training Ability to operate effectively and impact positively in a fast-paced and dynamic environment, as part of a multi
– location team.

Education and Experience:
Experience in a MD role with CMS and/or with a prime contractor working with CMS as RAC, MAC, QIO, or RVC Experience in the commercial health insurance industry or healthcare consulting/servicing firm Public relations experience with physician groups, beneficiary groups or Congressional offices.

Experience leading and managing Medical Directors and/or other senior non-clinical healthcare staff Experience practicing medicine as a board-certified Doctor of Medicine or Doctor who is currently licensed to practice medicine

Analytics, audit, and recovery services  for healthcare, government and student loans.