Internal Reference Number: R1048061
Summary Why should you join the BlueCross BlueShield of South Carolina family of companies?
Other companies come and go, but we've been part of the national landscape for more than seven decades, 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, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!
Position Purpose:
As member of the Pricing, Data Analysis and Coding (PDAC) team, the Associate Medical Director DME provides administrative oversight to the medical staff, analyzes medical review utilization data, researches new medical devices and technology, and acts as a resource to CMS, DMEPOS stakeholders, internal staff, on issues concerning medical device coding and DMEPOS policies. In this role, you will also oversee coding integrity efforts as well as write and revise coding advisory articles with regard to Medicare policy and procedure.Description
Logistics: Palmetto GBA - one of BlueCross BlueShield's South Carolina subsidiary companies.
Location: This position is full-time (40-hours/week) Monday-Friday. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. This role is located at our Government Programs Building at 17 Technology Circle, Columbia, SC OR can be REMOTE in the United States. There will be required travel for this position.
Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.
What You'll Do:
Supports operations in the form of case review on both medical and regulatory matters.
Develops claim adjudication criteria for situations requiring medical judgment.
Provides input on issues and operational policies, processes, and procedures.
Educates staff and medical community on various aspects of medical policy and program administration.
May develop and update medical policy in consultation with appropriate regulatory personnel, medical consultants, and professional societies.
Develops external relationships with the medical community and serves as liaison between these entities and the contractors.
Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization.
Conducts research into new or controversial medical procedures and technology.
To Qualify for This Position, You'll Need the Following:
Required Education: Doctoral degree Medical Doctor (MD) with current active license to practice medicine.
Required Experience:
Five years post graduate experience in direct patient care.
Required Skills and Abilities:
Excellent verbal and written communication skills.
Excellent customer service, organizational, and presentation skills.
Proficiency in spelling, punctuation, and grammar.
Ability to persuade, negotiate, or influence others.
Ability to work as a team member as well as a leader.
Knowledge of medical and utilization review techniques.
Required Software : Microsoft Office Software
Required License and Certificate: Active state medical license and current board certification in a recognized specialty.
We Prefer That You Have the Following:
Certified Professional Coding is preferred
Knowledge of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
Medicare A/B MAC or DME MAC
Experience working in rehabilitation
Three or more years in the healthcare insurance industry, a utilization form or other administrative experience in a health-related field that involved developing coverage and coding policies and guidelines.
Experience involving development of coverage and coding policies and guidelines under a Medicare program contract is preferred.
Our comprehensive benefits package includes the following:
We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.
Subsidized health plans, dental and vision coverage
401k retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Education Assistance
Service Recognition
National discounts to movies, theaters, zoos, theme parks and more
What We Can Do for You:
We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
What to Expect Next:
After submitting your application, our recruiting team members will review your resume to ensure you... For full info follow application link.
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.
