AnaheimRecruiter Since 2001
the smart solution for Anaheim jobs

Clinical Compliance Medical Director - Remote or Office Based

Company: Anthem Inc.
Location: Anaheim
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., Anaheim , Clinical Compliance Medical Director - Remote or Office Based, Executive , Anaheim, California

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


Program Manager (Medical)
Description: To apply visit Program Manager Medical Salary - 95,000 - 115,000 /YR DOE - Full Time Benefits Description Fralock is a well-established manufacturing company, based in the Santa Clarita Valley, (more...)
Company: Fralock
Location: Valencia
Posted on: 06/5/2020

Executive Assistant to CEO - Professional Services Firm
Description: As the Executive Assistant with this company you will be providing high level administrative support to this dynamic Chief Executive Officer. You will be the
Company: Confidential
Location: Los Angeles
Posted on: 06/5/2020

House Manager
Description: House Manager - Westside - 90- 140k-- Ultra-High Net Worth Family has an immediate need for an experienced House Manager-- to join their team. The ideal candidate will
Company: Confidential (In stealth mode)
Location: Los Angeles
Posted on: 06/5/2020


Technical Director - Unreal
Description: The Famous Group is seeking an experienced and agile individual with a go-getter attitude to join our team as a Technical Director - Unreal. In this role, you will be working with a team of CG Artists (more...)
Company: The Famous Group
Location: Los Angeles
Posted on: 06/5/2020

Associate Creative Director
Description: The Associate Creative Director-- is specifically responsible for the look and technical aspects
Company: JBCConnect
Location: Culver City
Posted on: 06/5/2020

Director, WW Creative Services, Studio
Description: The WW Creative Services Studio Director has a vision to build an operational and production center of excellence across multiple channels including print, digital, experiential, environmental, facilities, (more...)
Company: Herbalife LTD.
Location: Los Angeles
Posted on: 06/5/2020

Tax Manager - Best Small Firm!
Description: If you are a Tax professional with 5 years of experience, please apply Top Reasons to Work with UsWe are a small, full-service Los Angeles accounting firm that packs a big punch We offer auditing, consulting, (more...)
Company: CyberCoders
Location: Los Angeles
Posted on: 06/5/2020

Director Medical Staff
Description: JOB SUMMARY: -- Manages and Directs the Medical Staff Services Department in coordinating the activities of the Organized Medical Staff. -- EXPERIENCE/QUALIFICATIONS: Excellent verbal and written communication (more...)
Company: Valley Presbyterian Hospital
Location: Los Angeles
Posted on: 06/5/2020

Media Engineering Manager + up to a 5% Signing Reward
Description: Our client, a well-established global meeting company is seeking a Media Engineering Manager. The Media Engineering Manager
Company: Advantex
Location: Los Angeles
Posted on: 06/5/2020

Enterprise Account Manager
Description: Whitlock is looking for Enterprise Account Executives who are self-motivated with a proven track record of sales at the C-level and Director level. The successful candidate identifies opportunities, collaborates (more...)
Company: Whitlock
Location: Los Angeles
Posted on: 06/5/2020

Log In or Create An Account

Get the latest California jobs by following @recnetCA on Twitter!

Anaheim RSS job feeds