Medical Affairs Coordinator Jobs

Summary

We are currently hiring for a Medical Affairs Coordinator to join BlueCross BlueShield of South Carolina. In this role as Medical Affairs Coordinator, you will ensure that the Local Coverage Determination (LCD) process adheres to contract instructions; create, implement, and maintain 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.

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.

Description

Logistics

This position is full time (40 hours/week) Monday-Friday and will be fully remote (W@H).

What You Will Do

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

To Qualify For This Position, You Will Need

• Excellent verbal and written communication skills.
• 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).
• Ability to handle confidential or sensitive information with discretion.
• Excellent customer service, organizational, presentation, analytical OR critical thinking skills.
• Knowledge of managed care OR medical claims payment policy issues.
• Five years clinical experience in medical insurance, managed care, case management, OR claims management, OR a combination of these areas.
• Ability to persuade, negotiate, OR influence others.
• Working knowledge of word processing, spreadsheet software.
• For Division 33, Certified Genetic Counselor will be considered in lieu of RN License.
• Microsoft Office.
• Bachelor's degree - Nursing OR other health related field, OR associate degree in nursing with an active RN license.

What We Prefer

• Working knowledge of Microsoft Access OR other database software, DB2 and Easytrieve.
• Knowledge of government/healthcare programs and regulations, coding, and approval practices.
• MPH, MHA certifications.
• Knowledge of government/healthcare programs and contracts laws, regulations.
• Working knowledge of database software.
• Seven years-clinical experience in medical insurance, managed care, case management, OR claims management, OR a combination of these areas.
• Bachelor's degree – Nursing.
• HIAA, Loma, and/or ACLI certification.
• Knowledge of guidelines, benefits, and coverage for all lines of business.
• Knowledge of corporate administrative/medical policy for all lines of business.

What We Can Do for You

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

What To Expect Next

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and salary requirements.

Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.