Associate Medical Director DME

Why should you join the Blue Cross Blue Shield 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!

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.

Palmetto GBA – one of Blue Cross Blue Shield's South Carolina subsidiary companies.

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.

This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.

• 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.

• Required
  
  Education:
  
  Doctoral degree Medical Doctor (MD) with current active license to practice medicine.

• Five years post graduate experience in direct patient care.

• 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.

• Microsoft Office Software

• Active state medical license and current board certification in a recognized specialty.

• 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.

• Subsidized health plans, dental and vision coverage
• 401k…