RN Medical Affairs Coordinator

BlueCross BlueShield of South Carolina • Columbia, SC

3d • Remote

About The Position

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. The error rate is a factor in awarding and renewing Medicare/other contracts. Logistics This position is full time (40 hours/week) Monday-Friday 8:00-5:00 and will be W@H . U nrestricted RN license required

Requirements

• Bachelor's in a job related field OR Graduate of Accredited School of Licensed Practical Nursing or Licensed Vocational Nursing
• Required Work Experience: 5 years clinical experience in medical insurance, managed care, case management, or claims management, or a combination of these areas.
• Knowledge of managed care or medical claims payment policy issues.
• Working knowledge of word processing, spreadsheet software.
• Excellent verbal and written communication skills.
• Excellent customer service, organizational, presentation, analytical or critical thinking skills.
• Ability to persuade, negotiate, or influence others.
• Ability to handle confidential or sensitive information with discretion.
• Required Software and Tools: Microsoft Office.
• An active, unrestricted RN license from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC). For Division 33, Certified Genetic Counselor will be considered in lieu of RN License.

Nice To Haves

• Bachelor's degree- Nursing.
• 7 years-clinical experience in medical insurance, managed care, case management, or claims management, or a combination of these areas.
• Working knowledge of database software.
• Knowledge of government/healthcare programs and contracts laws, regulations.
• Knowledge of government/healthcare programs and 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.
• Working knowledge of Microsoft Access or other database software, DB2 and Easytrieve.
• HIAA, Loma, and/or ACLI certification.
• MPH, MHA certifications.
• Experience with molecular testing
• Experience with policy work

Responsibilities

• Provides clinical expertise, research, and judgment to develop Local Coverage Determinations(LCDS) under the direction of medical director.
• Maintains LCDS once developed.
• Educates providers and internal customers on LCDS.
• Communicates with other interdepartmental staff in appropriate coding and reimbursement guidelines to ensure coordination and compliance.
• Provides clinical input for internal requests.
• Serves as reviewer to determine inter-rater reliability.

Benefits

• 401(k) retirement savings plan with company match.
• Subsidized health plans and free vision coverage.
• Life insurance.
• Paid annual leave – the longer you work here, the more you earn.
• Nine paid holidays.
• On-site cafeterias and fitness centers in major locations.
• Wellness programs and healthy lifestyle premium discount.
• Tuition assistance.
• Service recognition.
• Incentive Plan.
• Merit Plan.
• Continuing education funds for additional certifications and certification renewal.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees