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Medical Affairs Coordinator (32706730)
Columbia, SC
Job Description
Seeking a RN to function as a Medical Affairs Coordinator. This position if fully remote. The schedule is M-F, 9am-5pm.
DUTIES:
Ensures that the Local Coverage Determination (LCD) process adheres to contract instructions. Creates, implements, and maintains educational tools to help providers reduce the submission of claims for non-covered services and reduce the claims payment error rate. Provides clinical expertise, research, and judgment to develop Local Coverage Determinations (LCDS). Provides clinical input for internal requests. Serves as reviewer to determine inter-rater reliability.
Required Skills and Abilities:
Knowledge of managed care or medical claims payment policy issues. Excellent verbal and written communication skills. Excellent customer service, organizational, presentation, analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion.
Required Software and Tools:
Microsoft Office. Working knowledge of database software. Knowledge of government/healthcare programs and contracts laws, regulations, coding, and approval practices. Knowledge of corporate administrative/medical policy for all lines of business. Knowledge of guidelines, benefits, and coverage for all lines of business.
Preferred Software and Tools: Working knowledge of Microsoft Access or other database software, DB2 and Easytrieve.
EDUCATION/REQUIREMENTS:
Bachelor's degree - Nursing or other health related field. OR, Associate's degree in Nursing with an active unrestricted RN license from the United States and in the state of hire.
Required Work Experience:
5 years clinical experience in medical insurance, managed care, case management, or claims management, or a combination of these areas.
Required License and Certificate:
An active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC).
DUTIES:
Ensures that the Local Coverage Determination (LCD) process adheres to contract instructions. Creates, implements, and maintains educational tools to help providers reduce the submission of claims for non-covered services and reduce the claims payment error rate. Provides clinical expertise, research, and judgment to develop Local Coverage Determinations (LCDS). Provides clinical input for internal requests. Serves as reviewer to determine inter-rater reliability.
Required Skills and Abilities:
Knowledge of managed care or medical claims payment policy issues. Excellent verbal and written communication skills. Excellent customer service, organizational, presentation, analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion.
Required Software and Tools:
Microsoft Office. Working knowledge of database software. Knowledge of government/healthcare programs and contracts laws, regulations, coding, and approval practices. Knowledge of corporate administrative/medical policy for all lines of business. Knowledge of guidelines, benefits, and coverage for all lines of business.
Preferred Software and Tools: Working knowledge of Microsoft Access or other database software, DB2 and Easytrieve.
EDUCATION/REQUIREMENTS:
Bachelor's degree - Nursing or other health related field. OR, Associate's degree in Nursing with an active unrestricted RN license from the United States and in the state of hire.
Required Work Experience:
5 years clinical experience in medical insurance, managed care, case management, or claims management, or a combination of these areas.
Required License and Certificate:
An active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC).
It is the policy of the Company to provide equal employment opportunities to all qualified individuals and to administer all aspects and conditions of employment without regard to the following:
• Race and associated traits, including hairstyle; Color, Age, Sex, Sexual orientation, Gender, Gender identity and gender expression; Religion, including dress and grooming practices; National origin, including language use restrictions; Pregnancy, childbirth, or breastfeeding; Marital or familial status; Genetic information, including family medical history; Physical or mental disability; Citizenship and/or immigration status
• Medical conditions, including cancer, AIDS/HIV, and occupational pneumoconiosis without respiratory impairment
• Denial of family or medical care leave
• Use of a guide or support animal
• Military or veteran status
• Political activities or affiliations
• Exercise of civil rights
• Domestic violence, assault, or stalking victim status
• GED certificate
• Arrest, expunged, or sealed records
• Application for or enrollment in Medi-Cal
• Status as a smoker or non-smoker
• Credit report or credit information
• Child or spousal support withholding
• Wage garnishment for consumer debt
• Relationship with someone with a disability
• Lawful conduct occurring during nonworking hours not on Company premises
• Any other protected class, in accordance with applicable federal, state, and local laws
Discriminatory, harassing, or retaliatory behavior is prohibited from coworkers, supervisors, managers, owners, and third parties, including clientele. The Company takes allegations of discrimination, harassment and retaliation very seriously and will promptly conduct an investigation when warranted. Equal employment opportunity includes, but is not limited to, employment, training, promotion, demotion, transfer, leaves of absence and termination.
DUTIES:
Ensures that the Local Coverage Determination (LCD) process adheres to contract instructions. Creates, implements, and maintains educational tools to help providers reduce the submission of claims for non-covered services and reduce the claims payment error rate. Provides clinical expertise, research, and judgment to develop Local Coverage Determinations (LCDS). Provides clinical input for internal requests. Serves as reviewer to determine inter-rater reliability.
Required Skills and Abilities:
Knowledge of managed care or medical claims payment policy issues. Excellent verbal and written communication skills. Excellent customer service, organizational, presentation, analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion.
Required Software and Tools:
Microsoft Office. Working knowledge of database software. Knowledge of government/healthcare programs and contracts laws, regulations, coding, and approval practices. Knowledge of corporate administrative/medical policy for all lines of business. Knowledge of guidelines, benefits, and coverage for all lines of business.
Preferred Software and Tools: Working knowledge of Microsoft Access or other database software, DB2 and Easytrieve.
EDUCATION/REQUIREMENTS:
Bachelor's degree - Nursing or other health related field. OR, Associate's degree in Nursing with an active unrestricted RN license from the United States and in the state of hire.
Required Work Experience:
5 years clinical experience in medical insurance, managed care, case management, or claims management, or a combination of these areas.
Required License and Certificate:
An active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC).
DUTIES:
Ensures that the Local Coverage Determination (LCD) process adheres to contract instructions. Creates, implements, and maintains educational tools to help providers reduce the submission of claims for non-covered services and reduce the claims payment error rate. Provides clinical expertise, research, and judgment to develop Local Coverage Determinations (LCDS). Provides clinical input for internal requests. Serves as reviewer to determine inter-rater reliability.
Required Skills and Abilities:
Knowledge of managed care or medical claims payment policy issues. Excellent verbal and written communication skills. Excellent customer service, organizational, presentation, analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion.
Required Software and Tools:
Microsoft Office. Working knowledge of database software. Knowledge of government/healthcare programs and contracts laws, regulations, coding, and approval practices. Knowledge of corporate administrative/medical policy for all lines of business. Knowledge of guidelines, benefits, and coverage for all lines of business.
Preferred Software and Tools: Working knowledge of Microsoft Access or other database software, DB2 and Easytrieve.
EDUCATION/REQUIREMENTS:
Bachelor's degree - Nursing or other health related field. OR, Associate's degree in Nursing with an active unrestricted RN license from the United States and in the state of hire.
Required Work Experience:
5 years clinical experience in medical insurance, managed care, case management, or claims management, or a combination of these areas.
Required License and Certificate:
An active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC).
It is the policy of the Company to provide equal employment opportunities to all qualified individuals and to administer all aspects and conditions of employment without regard to the following:
• Race and associated traits, including hairstyle; Color, Age, Sex, Sexual orientation, Gender, Gender identity and gender expression; Religion, including dress and grooming practices; National origin, including language use restrictions; Pregnancy, childbirth, or breastfeeding; Marital or familial status; Genetic information, including family medical history; Physical or mental disability; Citizenship and/or immigration status
• Medical conditions, including cancer, AIDS/HIV, and occupational pneumoconiosis without respiratory impairment
• Denial of family or medical care leave
• Use of a guide or support animal
• Military or veteran status
• Political activities or affiliations
• Exercise of civil rights
• Domestic violence, assault, or stalking victim status
• GED certificate
• Arrest, expunged, or sealed records
• Application for or enrollment in Medi-Cal
• Status as a smoker or non-smoker
• Credit report or credit information
• Child or spousal support withholding
• Wage garnishment for consumer debt
• Relationship with someone with a disability
• Lawful conduct occurring during nonworking hours not on Company premises
• Any other protected class, in accordance with applicable federal, state, and local laws
Discriminatory, harassing, or retaliatory behavior is prohibited from coworkers, supervisors, managers, owners, and third parties, including clientele. The Company takes allegations of discrimination, harassment and retaliation very seriously and will promptly conduct an investigation when warranted. Equal employment opportunity includes, but is not limited to, employment, training, promotion, demotion, transfer, leaves of absence and termination.
Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
Associate Degree
Required Experience
5+ years
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