Medical Director

🕒 April 28

🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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Availity

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2000

⚕️ Healthcare Insurance

☁️ SaaS

🔌 API

💰 Secondary Market on 2021-07

Healthcare Insurance • SaaS • API

Availity is a leading health information network that connects payers, providers, and technology partners in the healthcare industry. By facilitating over 13 billion clinical, administrative, and financial transactions annually, Availity streamlines payer-provider collaboration and enhances patient care through an integrated provider engagement platform. The company's solutions leverage artificial intelligence and interoperability to automate processes such as prior authorizations, revenue cycle management, and payment accuracy, ultimately reducing costs and improving efficiency across the healthcare ecosystem.

📋 Description

• Lead a team of UM RN Analysts responsible for producing Availity’s Auth AI platform • Provide input and oversight of interpretation of payer medical policy guidelines • Construct NLP/AI–enabled attestation trees reflective of medical necessity criteria • Ensure effective flow of tasks related to medical policy creation • Develop working knowledge of domain-specific programming language and use development tools • Enhance validity and accuracy of NLP outputs and identify additional medical terms

🎯 Requirements

• MD/DO with at least 8 years of clinical experience • At least 5 years of experience in healthcare revenue cycle roles including Utilization Management, prior authorization, claims appeals/denials • Prior experience working in healthcare information technology and with cross-functional teams is a plus • Deep knowledge of the healthcare insurance industry and relevant state and federal regulations is a plus • Experience working or interacting with payer medical policy teams • Exceptional critical thinking and reasoning skills • Ability to synthesize complex, abstract problems and collaborate effectively • Self-motivated and a quick learner with ability to multi-task • Strong leadership and delegation skills • If still practicing medicine, a passion for fixing the system

🏖️ Benefits

• Competitive salary • Bonus structure • Generous HSA company contribution • Healthcare, vision, dental benefits • 401k match program available on day one • Unlimited PTO for salaried associates + 9 paid holidays • Hourly associates start at 19 days of PTO with the same holiday benefits • Wellness reimbursement up to $250/year for gym memberships, racing events, weight management programs • Education reimbursement • Paid Parental Leave for both moms and dads • Community service opportunities