Medical Director (Medtech)

TL;DR

Medical Director (Medtech): Serving as a clinical subject matter expert and physician leader for audit programs supporting governmental and commercial payer programs. Focus on providing medical oversight for audit strategy, clinical review methodologies, and ensuring findings are clinically sound, evidence-based, and aligned with regulatory standards.

Location: Must be based in the US

Company

hirify.global is a healthcare intelligence company providing an AI-powered platform to maximize financial outcomes and drive down healthcare costs for health plans.

What you will do

• Provide clinical leadership and medical oversight for audit programs involving governmental and commercial payer claims.
• Review and interpret medical records, claims data, and clinical documentation to support accurate audit determinations.
• Evaluate medical necessity, level of care, coding accuracy, and alignment with clinical standards.
• Partner with audit operations, coding, data analytics, compliance, and legal teams to resolve complex payment integrity issues.
• Provide physician-level support for disputes, grievances, appeals, and provider-facing clinical explanations.
• Participate in the development of clinical audit guidelines, review protocols, and reviewer training materials.

Requirements

• Medical degree (MD or DO) required.
• Active, unrestricted medical license in good standing required.
• Minimum of 5+ years of direct clinical patient care experience post-residency or fellowship required.
• Must be authorized to work in the US.
• Strong understanding of governmental and commercial payer operations, including Medicare, Medicaid, and Medicare Advantage.
• Demonstrated ability to interpret payer policies, medical necessity criteria, and coding standards.

Nice to have

• Board certification in an ABMS or AOA-recognized specialty.
• Experience in an audit company, payer organization, or payment integrity vendor.
• Experience with utilization management, claims audit, or appeals.

Culture & Benefits

• Opportunity to work with a leading AI-powered healthcare intelligence platform.
• Collaborative environment working alongside a team of Medical Directors.
• Commitment to equal employment opportunity and inclusive workplace practices.
• Participation in E-Verify as required by law.