Medical Affairs Research Anlst - Novitas

GuideWell Source • Remote, OH

2d • Remote

About The Position

Are you interested in joining a team of experienced healthcare experts and have the ability to shape and transform the healthcare delivery system? At our family of companies, everything we do is to help improve the lives of the nearly 12 million Medicare beneficiaries we serve and 700,000 health care providers who care for them. It is our goal to help create a better health experience for all consumers. Join our winning culture and help transform Medicare for the millions of people who rely on its services.

Requirements

• High School Diploma or GED
• 4 year's related work experience in Medicare operations, claims review, case review, education, and/or medical & payment policy including Medicare and health insurance coding experience (CPT, HCPCS, ICD-10, etc.)
• Demonstrated proficiency in Multi-Carrier System (MCS) and Federal Intermediary Standard System (FISS) research
• Demonstrated proficiency in Medicare guidelines and related research
• Demonstrated proficiency using Microsoft applications: Word, Excel, PowerPoint
• Demonstrated proficiency with Internet research
• Demonstrated excellent oral and written skills
• Demonstrated excellent organization and tracking skills
• Demonstrated experience and confidence leading a large group meeting with external stakeholders

Nice To Haves

• Medicare education experience (e.g., Provider Outreach and Education, Critical Inquiries, Targeted Education)
• Proficiency in Medical Terminology
• CPC, CEMC, CHC-H, or equivalent certifications

Responsibilities

• Independently research and respond in a professional and comprehensive manner to internal and external inquiries received by the Contractor Medical Directors (CMDs), of a clinical/medical nature, and regarding any of the tasks performed within the Medical Affairs department including Local Coverage Determination (LCD) and Article development and maintenance, local claims processing edits, as well as local pricing and fee development.
• Responsible for comprehensive Medicare research and thorough understanding of the rules and regulations to develop answers to the most challenging correspondence received from providers and stakeholders. Research areas include but are not limited to the following: Medicare rules and guidance, Specific claim research (Medicare Claims System and Federal Intermediary Standard System), Local coverage, Billing and coding, Payment and fees.
• Responsible for comprehensive responses via email or conference call to provide accurate and timely information and education to customers.
• Collaboration with the Medical Policy team to ensure proper handling of New LCD Requests and LCD Reconsideration Requests.
• Tracking and monitoring of correspondence and related tasks to ensure timely and accurate completion per CMS requirements.
• Represent the company to clinical experts, stakeholders, and interested parties in the Company's jurisdictions who work with the Medical Policy team, CMDs, and Pricing Consultants by coordinating and hosting teleconferences and webinars including the following: Contractor Advisory Committee Meeting (CAC) -- Host of the jurisdictional evidentiary meeting including maintenance of the CAC roster, conflict of interest disclosures and other forms, education and various communications; Open Meeting -- Host of the jurisdictional LCD comment meeting including handling of various presenter forms, education and communications; Informal Meeting -- education and communication; Any interested party who wants to speak to a Contractor Medical Director; Stakeholder meetings regarding the LCD and Article process; Stakeholder meetings regarding local fee development or revision; National workgroup meetings.
• Development and maintenance of education and materials pertinent to the various functions within Medical Affairs including but not limited to LCDs and Articles, CAC and Open Meetings, local pricing, and Investigational Device Exemptions.
• Independently review IDE requests from customers to ensure completeness and accuracy.
• Educate customers on the request and review process.
• Respond accurately and timely to all requests.
• Update the claims processing system to allow proper processing of claims submitted by approved providers.
• Tracking and monitoring of IDEs and related tasks to ensure timely and accurate completion per CMS requirements.
• Performs other duties as the supervisor may, from time to time, deem necessary.

Benefits

• Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire
• Short- and long-term disability benefits
• 401(k) plan with company match and immediate vesting
• Free telehealth benefits
• Free gym memberships
• Employee Incentive Plan
• Employee Assistance Program
• Rewards and Recognition Programs
• Paid Time Off and Paid Sick Leave

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED