Clinical Program Director
Specialty Search GroupDallas, TX, US6 hours ago
Job type
- Full-time
Job description7–10 years of healthcare experience, with 5+ years in formulary or benefit management. Strong knowledge of claims adjudication, reimbursement operations, and coding standards. Advanced Excel skills (pivot tables, lookups, reconciliations). Coding certifications (CPC, CCS, CMRS) preferred. Detail-oriented with strong analytical and communication skills.
Job Description
A growing healthcare technology organization is seeking a Clinical Program Director of Formulary to oversee the accurate and timely implementation of formulary data across medical benefit drugs, DMEPOS, immunizations, vaccinations, and test-and-treat services. This role ensures fee schedules and coding data are complete, compliant, and optimized for claims processing.
Key Responsibilities
- Lead the review, update, and maintenance of formulary files and fee schedules.
- Ensure compliance with federal / state payer rules and policies.
- Act as subject matter expert in coding (HCPCS, CPT, NDC, ICD-10).
- Oversee quality checks, pricing validations, and data accuracy.
- Collaborate with internal teams and external partners to align systems and workflows.
- Monitor regulatory updates and recommend system or process changes.
Qualifications
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Clinical Program Director • Dallas, TX, US
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