Director, Clinical Review - 1348053
Description
Assists the Senior Vice President of Compliance in providing coordination, direction and oversight of the PHC Government Appeals Division. Provides advice and counsel to all affiliates, including operations and employed physician practices, performs administrative appeals coordination and representation for government audits as well as some litigation management. Assists Government Appeals Division and executive management with coordination and consolidation of business operations.
Qualifications
MINIMUM EDUCATION REQUIRED:
J. D. degree from a recognized law school is required.
MINIMUM EXPERIENCE REQUIRED:
Clinical experience in healthcare setting for minimum 8 years with chart review with ability to draft and file narratives in support of medical claims for administrative appeals process.
ADDITIONAL PREFERRED QUALIFICATIONS:
Experience in health care contracting, legal and compliance issues, including significant experience dealing with government regulations relating to contracting, health care law and compliance program implementation, and general statutory issues. Experience supervising legal and compliance staff is preferred. Strong interpersonal and influencing skills. Ability to explain and persuade by articulation and use of specific personal experiences to convey the importance and significance of issues. Skill in stressing prevention as opposed to reaction.
Job: Leadership
Primary Location:United States-Georgia-Atlanta
Organization: Piedmont Healthcare
Schedule: Full-time
Job Posting: Mar 26, 2013, 1:38:27 PM
Description
Assists the Senior Vice President of Compliance in providing coordination, direction and oversight of the PHC Government Appeals Division. Provides advice and counsel to all affiliates, including operations and employed physician practices, performs administrative appeals coordination and representation for government audits as well as some litigation management. Assists Government Appeals Division and executive management with coordination and consolidation of business operations.
Qualifications
MINIMUM EDUCATION REQUIRED:
J. D. degree from a recognized law school is required.
MINIMUM EXPERIENCE REQUIRED:
Clinical experience in healthcare setting for minimum 8 years with chart review with ability to draft and file narratives in support of medical claims for administrative appeals process.
ADDITIONAL PREFERRED QUALIFICATIONS:
Experience in health care contracting, legal and compliance issues, including significant experience dealing with government regulations relating to contracting, health care law and compliance program implementation, and general statutory issues. Experience supervising legal and compliance staff is preferred. Strong interpersonal and influencing skills. Ability to explain and persuade by articulation and use of specific personal experiences to convey the importance and significance of issues. Skill in stressing prevention as opposed to reaction.
Job: Leadership
Primary Location:United States-Georgia-Atlanta
Organization: Piedmont Healthcare
Schedule: Full-time
Job Posting: Mar 26, 2013, 1:38:27 PM
