Associate Medical Director DME

BlueCross BlueShield of South Carolina•Columbia, SC

12d•$206,011 - $413,523•Remote

About The Position

As member of the Pricing, Data Analysis and Coding (PDAC) team, the Associate Medical Director DME provides administrative oversight to the medical staff, analyzes medical review utilization data, researches new medical devices and technology, and acts as a resource to CMS, DMEPOS stakeholders, internal staff, on issues concerning medical device coding and DMEPOS policies. In this role, you will also oversee coding integrity efforts as well as write and revise coding advisory articles with regard to Medicare policy and procedure.

Requirements

Doctoral degree Medical Doctor (MD) with current active license to practice medicine.
Five years post graduate experience in direct patient care.
Excellent verbal and written communication skills.
Excellent customer service, organizational, and presentation skills.
Proficiency in spelling, punctuation, and grammar.
Ability to persuade, negotiate, or influence others.
Ability to work as a team member as well as a leader.
Knowledge of medical and utilization review techniques.
Microsoft Office Software
Active state medical license and current board certification in a recognized specialty.

Nice To Haves

Certified Professional Coding is preferred
Knowledge of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
Medicare A/B MAC or DME MAC Experience working in rehabilitation
Three or more years in the healthcare insurance industry, a utilization form or other administrative experience in a health-related field that involved developing coverage and coding policies and guidelines.
Experience involving development of coverage and coding policies and guidelines under a Medicare program contract is preferred.

Responsibilities

Supports operations in the form of case review on both medical and regulatory matters.
Develops claim adjudication criteria for situations requiring medical judgment.
Provides input on issues and operational policies, processes, and procedures.
Educates staff and medical community on various aspects of medical policy and program administration.
May develop and update medical policy in consultation with appropriate regulatory personnel, medical consultants, and professional societies.
Develops external relationships with the medical community and serves as liaison between these entities and the contractors.
Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization.
Conducts research into new or controversial medical procedures and technology.