Medical Affairs Coordinator - West Columbia, United States - Professional Management Enterprises

Professional Management Enterprises West Columbia, United States

4 days ago

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.

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).

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