Medical Director, Payer Clinical Services (US Remote)

At Trend Health Partners, a tech-enabled payment integrity company, our mission is to facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. We achieve this by aligning the common goals of payers and providers and fostering collaboration through a shared technology platform and seamless workflows.

Joining Trend Health Partners means becoming a part of a dynamic growing organization that promotes a collaborative and innovative work environment. Our comprehensive compensation package includes competitive salaries, highly valued health insurance, a 401(k) plan with employer match, paid parental leave, and more.


The primary responsibility of the Medical Director is to provide physician-level clinical oversight, strategic guidance, and escalation support across DRG validation, HBA (hospital bill audit), IBR (itemized bill review), Clinical appeals, Readmissions/data mining, and Payer-facing clinical discussions.

• Appeals work.
• Peer-to-peer review of individual claims  
• Analyze appeal outcomes and make improvements to our concepts/review guidelines.
• Signoff on our clinical validation concepts as well as our coding concepts
• Provide thorough review of each concept and the supporting references
• As needed input for QA reviews

• This job description documents the general nature and level of work but is not intended to be a comprehensive list of activities, duties, or responsibilities required for this position. Consequently, employees may be asked to perform other duties as required.
• Employees may also be asked to complete certain compliance requirements set forth by our Business Partners in the performance of their jobs including but not limited to requests for background and drug screenings and disclosures of personal health information or personally identifiable information. Exemptions as provided under the ADA and TITLE VII of the Civil Rights Act will be observed and followed.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the functions outlined above.