Supv Medical Policy - Novitas (RN)

GuideWell Source

8d • 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.

SUMMARY STATEMENT
Serves as department supervisor and project lead for the Local Coverage
Determination (LCD) and Local Coverage Article (Article) development and
maintenance function for assigned company. This includes varied and highly
visible requirements of the company's current CMS contracts.

Requirements

• High School Diploma or GED
• 3 years' related work experience in clinical field (e.g., Registered Nurse, Physician's Assistant or Physical Therapist), experience in Health or Business Administration, Medicare, health insurance experience in operations, claims review, case review, education, and/or medical and payment policy, and health insurance coding (e.g., ICD-9-CM, CPT/HCPCS).
• 2 years' direct supervisory/project management lead or other leadership experience.
• Proficient in research of the CMS Internet-Only manual (IOM) and national and local coverage decisions
• Comprehensive knowledge of medical, surgical and diagnostic procedures and terminology
• Proficient in MS Office applications and Internet research
• Excellent written and oral communication skills
• Ability to communicate with confidence with other medical professionals, Medical Societies, Medicare providers, CMS and Contractor Advisory Committee (CAC) members
• Professional demeanor and positive approach to work
• Excellent planning, organizing, time and work management skills
• Active and current medical professional licensure - Registered Nurse (RN) license

Nice To Haves

• Direct supervisory experience 5+ years' related work experience
• Certified Professional Coder (CPC) credential

Responsibilities

• Oversees and supervises the related LCD processes such as annual and other mandatory updates (e.g., ICD-9-CM, annual reviews, Current Procedural Terminology (CPT) /Healthcare Common Procedure Coding System (HCPCS updates, Change Request updates, etc.).
• Ensures LCDs are accurate and updated in a timely manner, based on national coding guideline changes and CMS requirements.
• Solicits and incorporates feedback and input from CMDs as needed relative to such changes.
• Oversees and supervises the policy team responsible for the LCD and Article development function which includes the following tasks
• Identify and refine list of potential new LCD topics and revisions to existing LCDs based on ever-evolving medical standards, new technology, new drug development and data analysis.
• Directs the Medical Policy Team relative to timelines and deliverables relative to LCD development and revisions, Contractor Advisory Committee (CAC) meeting cycles and CMS requirements.
• Ensures timely completion and delivery of LCD "product" to internal and external stakeholders.
• Oversees and supervises the team responsible for the timely and accurate preparation for posting and maintenance of LCDs and Articles on the company website, and separately but identically on the Centers for Medicare and Medicaid Services (CMS) national Medicare Coverage Database (MCD) in accordance with the CMS regulatory guidance and requirements.
• Interfaces with both technical and professional clinical personnel; routinely interacts with all levels of staff within the company as well as entities from other MACs.
• Gains clinical understanding and impacts of LCDs from Contractor Medical Directors (CMDs) (internal) and other MAC's CMDs (external).
• Shares LCD impacts with operational areas.
• Educates internal team members on system and processing changes resulting from operationalizing LCDs.
• Maintains regular and ongoing communication with external customers and professionals external to the company (e.g., state Medical Societies, other professional societies or organizations, Medicare providers, CMS, and CAC members) to ensure adequate information sharing/education.
• Works with Provider Outreach and Education (POE) to develop proactive communication and education regarding new and revised LCDs.
• Supervises the team that responds to inquiries from providers and other external entities regarding LCDs.
• Maintains regular and ongoing communications with internal customers regarding LCD and Article activities to ensure adequate information sharing/education as appropriate throughout the company.
• Provides updates to internal and external stakeholders regarding LCD status.
• Provides education to internal stakeholders regarding LCD impact and ensures staff understanding of system and processing implications.
• Oversees and supervises the team that is responsible for the department's preparation for the CAC meetings which includes the following tasks:
• Ensures the coordination of CAC meeting logistics with internal (e.g., POE, contract administration) and external parties (e.g., vendors, hosts, etc.), to include items such as venue, accommodation and technology.
• Ensures timely delivery of CAC materials to all physician members of CAC committee.
• Attends CAC meetings to support CMDs and Medical Affairs Manager.
• Assists manager in project management responsibilities, including preparation of workload, budget, and other reporting related to LCDs and Articles.
• Supports management with monthly workload reporting, budgeting and other administrative tasks as assigned.
• 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