Medical Director

The Medical Director is responsible for overseeing every chart . This involves reviewing the medical chart to ensure an accurate representation of a patient's clinical status has been translated into coded data. The Medical Director is responsible for capturing the true clinical picture in a manner compliant with federal laws and the healthcare organization’s information privacy practices through identification of coding and physician query opportunities.

The Medical Director works with the CDI team to confirm the principal diagnosis and the appropriate Diagnosis Related Group of every case in compliance with coding guidelines. This process also involves the Medical Director confirming procedures, dates, and a complication or comorbidity (CC) or a major complication or comorbidity (MCC) when used as a secondary diagnosis. The Medical Director validates clinical indicators for coded diagnoses, capturing the patient’s condition and ensuring the accuracy of the severity of illness and risk of mortality for the patient to illustrate the true clinical picture of the episode of care.


Primary Responsibilities
Provide clinical leadership in an inter-disciplinary team in a professional, knowledgeable, and efficient manner to drive client results, exceed client expectations, and foster client confidence
Maintain a functional and collaborative relationship with the DRG Coding Auditor to achieve shared company goals
Comply with medical and federal guidelines at all times
Resolve conflicts quickly and professionally
Stay up to date with medical guidelines, advancements within his or her field, and client-specific criteria
Responsible for the quality of his/her work by developing and implementing strategic goals related to quality improvement.

Responsible for generating compliant queries based on appropriate clinical indicators for each diagnosis. Every query must meet all regulatory and reporting requirements
Work with his/her manager to review analytics, identifying trends and actionable steps to improve opportunity capture rate and drive results for clients

Work with Senior Management and Compliance Officer to adhere to organizational goals and mission
Participate in corporate educational activities
Utilize all technology, tools, and resources to enhance performance and will be proficient in navigation of various electronic medical records
Excel in a fast-paced, rapidly changing environment
Meet expectations in performance regarding productivity and quality of his/her tower work, professionalism, and professional growth
Perform miscellaneous job-related duties as assigned