Medical Director

Cotiviti

Medical Director advising health plans on medical payment policy, coding, and claims accuracy. Leading client strategy and policy validation for Cotiviti’s healthcare analytics business.

Posted 8/14/2026full-timeRemote • 🇺🇸 United StatesLead💰 $225,000 - $275,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise as a Licensed MD/DO with a strong background in health plan operations, medical policy, and clinical medicine. Proven ability to build professional relationships, deliver high-quality analytics, and present effectively to diverse audiences.

Highest-signal resume keywords

Licensed MD/DOMedical Policy ExpertiseHealth Plan Operations ExperienceAdvanced Excel ProficiencyStrong Analytical Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical CodingClaims AdjudicationPayment IntegrityFraud, Waste, and AbuseData AnalyticsClinical LiaisonMedical Policy EditsResearch and DevelopmentClient Data ReviewProblem-Solving

Soft Skills

Strong Organizational SkillsExcellent Verbal CommunicationExcellent Written CommunicationRelationship BuildingAdaptability

Tools & Technologies

Microsoft Office SuiteExcelPowerPointWord

Industry Keywords

Health PlanMedical DirectorClinical MedicineMedical Policy TeamMedical Payment Policy

About the role

Key responsibilities & impact

Support existing client growth and new sales activity by identifying value-creation opportunities
Present appropriate payment policy to clients for adoption based on data analytics review
Define mission and strategy with the Client Engagement Leader and deliver strategy to the client’s medical policy team
Work with the Medical Policy team to evaluate and validate editing
Act as a clinical liaison with health plan clients
Guide research and development efforts for Medical Policy and Solutions teams
Serve as a subject matter expert in claims, claims adjudication, medical policy edits, and configurations
Build trust and credibility, deliver on commitments, and provide value-added analytics
Assist in discovering opportunities for other Cotiviti product sales
Direct the joint Medical Policy Committee with health plan MDs, coding experts, and payment integrity professionals
Review client data, select medical policy to present, and provide clinical and coding expertise and backend support for the client’s Medical Director
Evolve as a trusted advisor to the health plan on medical payment policy
Perform other duties as assigned

Requirements

What you’ll need

Licensed MD/DO with clinical and health plan experience
Experience in health plan operations as a Medical Director, focused on medical policy, medical coding, payment integrity, and/or fraud, waste, and abuse
Experience in clinical medicine
Ability to adapt to rapidly changing priorities and workloads, multitask, prioritize, and meet deadlines
Ability to develop strong professional relationships across multiple roles and levels
Comfortable presenting to small and large groups
Strong organizational, analytical, and problem-solving skills
Results-driven focus on high-quality, error-free service and deliverables
Ability to work independently and in a team environment
Excellent verbal and written communication skills
Proficiency with Microsoft Office Suite, including Word, Excel, and PowerPoint
Advanced Excel proficiency preferred
Approximately 10% travel required
Able to use a computer keyboard for extended periods
After-hours and/or weekend work may be required for major deliverables or deadlines
Must provide a dedicated, secure work area
Must provide high-speed internet access/connectivity and office setup and maintenance
Must be able to remain stationary, often standing or sitting for prolonged periods
Must be able to perform repetitive motions involving the wrists, hands, and/or fingers

Benefits

Comp & perks

Discretionary bonus consideration
Medical insurance coverage
Dental insurance coverage
Vision insurance coverage
Disability insurance coverage
Life insurance coverage
401(k) savings plans
Paid family leave
9 paid holidays per year
17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service
Work-at-home arrangement
Dedicated, secure work area and high-speed internet access/connectivity and office setup and maintenance required