RN Medical Affairs Coordinator

Other Jobs To Apply

No other job posts for this day.

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. Description Logistics This position is full time (40 hours/week) Monday-Friday 8:00-5:00 and will be W@H. Unrestricted RN license required What You Will Do: 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.

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.

Requirements

  • Bachelor's in a job related field OR Graduate of Accredited School of Licensed Practical Nursing or Licensed Vocational Nursing
  • 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.
  • 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

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.
Back to blog

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...