Medical Director (Medical Policy & Operations) - (Columbus, OH)

Required ID: 55916BR JOB DESCRIPTION The Medical Director MPO (Medical Policy & Operations) is responsible for providing clinical ability and business direction in support of medical management programs to promote the delivery of high-quality, constituent focused medical care with a focus clinical and payment policy. Knowledge of Aetna clinical and coding policy and experience with appeals, claim review, reimbursement issues, and coding is preferable, but a willingness to learn is essential. Fundamental Components: Basic responsibilities of this Medical Director include support of the appeal process, clinical claim review process, precertification, and predetermination of covered benefits in the commercial and Medicare environment. This Medical Director provides subject matter ability in clinical and payment policy to provide clinical support and business direction in these areas.