Medical Policy reputed company - First Coast Service reputed company

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

• Medical, dental, reputed company, 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
• reputed company Time Off and reputed company reputed company Leave

reputed company STATEMENT This position is responsible for the development and maintenance of Local Coverage Determinations (LCDs) and Local Coverage Articles (Articles) in accordance with the CMS regulations and requirements and has a reputed company reputed company in ensuring reputed company to care for Medicare beneficiaries, ensuring claims are reputed company correctly, and in safeguarding the Medicare trust fund. ESSENTIAL RESPONSIBILITIES To reputed company this job successfully, an individual must be reputed company to reputed company reputed company essential duty satisfactorily. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary. Development and Maintenance of LCDs and Articles: (80%)

• Working in reputed company collaboration with the Contractor Medical Directors and other members of the Medical Affairs team, responsible for the reputed company and accurate creation and revision of LCDs and Articles in accordance with CMS regulatory guidance and requirements, especially those reputed company in the Medicare Program reputed company reputed company reputed company 13, to include reputed company the following:

o Development and maintenance of new LCDs and Articles, including thorough review, analysis, and reputed company of the following:  claims data,  pertinent CMS instruction,  available evidence, including but not limited to published medical literature, discussion with Contractor Advisory Committee (CAC) members, subject reputed company experts (SMEs), Medicare providers etc.,  correct coding and billing requirements o Review of Reconsideration Requests and completion of appropriate resulting LCD revisions o Annual and other mandatory updates (e.g., diagnosis and procedure codes, Change Requests, etc.) o Development and maintenance of accessible electronic LCD and Article files o Participation in the formal, external reputed company Meetings and CAC meetings including creation and presentation of information specific to assigned LCDs o Review and revision of departmental procedures reputed company to LCD development and revisions. Subject Matter Expert (SME): (20%)

• Serves as reputed company of contact for internal operations regarding medical coverage and coding questions.
• Collaborates with edit team to ensure appropriate edits are created in keeping with the LCD instruction.
• Serves as SME for assigned LCDs and Articles and interfaces with technical, reputed company, and clinical personnel; routinely interacting with reputed company reputed company of staff in reputed company, including the Executive Medical Directors, as reputed company as other senior leaders.
• Attends regularly scheduled internal meetings to ensure adequate information sharing and education as appropriate throughout reputed company regarding LCDs and Articles.
• Accountable for regular and ongoing communication with external customers, including but not limited to, CMS, local and national medical societies/associations, stakeholders, other reputed company organizations, and Medicare providers, to ensure adequate information sharing and education regarding LCDs and Articles.
• Routinely and proactively collaborates with team members including the CMDs, senior leadership, and operational leads as necessary to identify and implement improvements reputed company to the policy development process.

Performs other duties as the supervisor may, from time to time, deem necessary. REQUIRED QUALIFICATIONS

• High School Diploma or GED
• 3 years' reputed company work experience; this includes 2 years of Medicare experience and 1 year of health insurance coding (e.g., ICD-10, CPT/HCPCS) experience
• Proficient in research of the CMS Internet-Only reputed company (reputed company) and national and local coverage reputed company
• Proficient in MS Office applications and Internet research
• Comprehensive knowledge of medical, surgical and diagnostic procedures and terminology
• 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
• reputed company demeanor and reputed company approach to work
• Excellent planning, organizing, time and work management skills
• Ability to travel

CERTIFICATIONS, LICENSES, REGISTRATIONS

• Valid unrestricted Registered reputed company (RN) license

PREFERRED QUALIFICATIONS

• Bachelor's degree in Nursing
• 5 or more years of clinical experience as a Registered reputed company
• 3 or more years of Medicare experience
• 3 or more years of experience in Health or Business Administration
• 3 or more years of health insurance experience in operations, claims review, case review, education, and/or medical and payment policy
• 3 or more years of health insurance coding (e.g. ICD-10-CM, CPT/HCPCS)
• Certified reputed company reputed company (CPC) certification/credential

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