Medical Policy Specialist I - 300126

Position is eligible for Remote/Work from Home opportunity

Job Summary

The Medical Policy Specialist (MPS) provides administrative support and research as part of the medical policy function of Noridian Healthcare Solutions (NHS). This position updates and creates policy documentation, performs claims research, and provides assistance to the medical directors, medical policy staff, and other organization staff.

Key Performance Indicators

• Excellent customer service
• Prioritization and organization skills and adapts to changes in workload as needed
• Strong attention to detail and effective communication skills

Essential Functions

Title: Medical Policy Specialist I

FLSA Category: Non-Exempt

Key Duties/Responsibilities/Accountabilities

• Handles day-to-day medical related policy communication with internal NHS departments, the provider community, and the Centers for Medicare & Medicaid Services (CMS).
• Monitors and logs the Part A and B Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), and Coverage Articles Reconsiderations.
• Transfers comments received for draft LCDs.
• Updates Medical Policy on the organization's website.
• Participates in workgroup conferences or other pertinent NHS medical policy meetings and prepares minutes (e.g. Internal policy, medical policy, and team meetings).
• Assists medical directors and medical policy staff with researching claims denials and reviewing processing instruction, guidelines, and coverage issues.
• Monitors the CMD OnBase queue.
• Ensures all medical policy workloads are processed timely and accurately as outlined in the Program Integrity Manual.

Non-Essential Duties and Functions

• Other duties as assigned.


Requirements

Qualifications

Minimum Qualifications:

Title: Medical Policy Specialist I

• Associate's degree in Medical Coding, Medical Assistance, Medical Secretary, or closely related field
• CPC, CPC-H, or CPSC-H certification fulfills the Associate's degree requirement as may two or more years of clearly successful coding experience in one who is working on but not yet completed certification

Preferred Qualifications:

Title: Medical Policy Specialist I

• Above requirements and the following:
• Coding certification through American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA)
• Additional clinical registration, certification, or licensure

Segregation of Duties

Every employee is responsible to perform their duties and responsibilities in accordance with Noridian values, policies and procedures, including but not limited to, Segregation of Duties Principles, HIPAA Security and Privacy, CMS requirements, the Noridian Compliance Program, and any other applicable laws, rules and regulations.

Statement of Other Duties

This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functions. Employees may be requested to perform job related tasks other than those specifically listed in this description, and may be required to perform any task requested by the supervisor or by management.

CMS Access Compliance and Regulation Contingency Statement

Some positions require compliance with (i) federal and agency-specific regulations and related clauses included in NHS's prime contracts with the Government, (ii) background checks, and (iii) eligibility for a government-issued identification card.

Other Information

Job Posting Policy 6.05

New employees with Noridian Healthcare Solutions will be eligible to apply for positions within their assigned department after successfully completing a 90-day review. For positions outside your department, you must attain a minimum of six months of service before you can apply.

Equal Employment Opportunity

Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.

For questions, please email careers@noridian.com.

This job posting will be closed 10/31/2018 at 8:00AM CST. No further applications will be considered.