Medical Affairs Coordinator

Job Title: Medical Affairs Coordinator
Location: Columbia, SC 29203. (Remote)
Duration: 12 months assignment with possible conversion
Shift: Mon - Fri, 9am to 5pm EST. May require additional time/effort when needed
Payrate: $38/hr
Note: 2-3 rounds of interviews

Summary:
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.

Responsibilities:

• 50% Provides clinical expertise, research, and judgment to develop Local Coverage Determinations(LCDS) under the direction of medical director. Maintains LCDS once developed.
• 35% Educates providers and internal customers on LCDS. Communicates with other interdepartmental staff in appropriate coding and reimbursement guidelines to ensure coordination and compliance.
• 15% Provides clinical input for internal requests. Serves as reviewer to determine inter-rater reliability.

Required Education: Bachelor's degree - Nursing or other health related field. OR, Associate's degree in Nursing with an active RN license.
Required Work Experience: 5 years clinical experience in medical insurance, managed care, case management, or claims management, or a combination of these areas.
Required License and Certificate: 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.Preferred Education: Bachelor's degree- Nursing.

Preferred Work Experience: 7 years-clinical experience in medical insurance, managed care, case management, or claims management, or a combination of these areas.
Preferred Licenses and Certificates: HIAA, Loma, and/or ACLI certification. MPH, MHA certifications. Languages: English.