Medical Director

Serve as a physician leader and clinical subject matter expert for an audit organization supporting governmental and commercial payer programs. Provide medical oversight for audit strategy, clinical review methodologies, coding and documentation interpretation, claims validation, medical necessity determinations, and appeal support. Ensure findings are evidence-based and consistently applied across Medicare, Medicaid, Medicare Advantage, managed care, and commercial plan policies, while partnering with cross-functional teams to resolve complex payment integrity issues.