Medical Affairs Research Anlst - Novitas - Remote, FL

United States of America-USAUS

Are you interested in joining a team of experienced healthcare experts and have the ability to shape and transform the healthcare delivery system? At our family of companies, everything we do is to help improve the lives of the nearly 12 million Medicare beneficiaries we serve and 700,000 health care providers who care for them. It is our goal to help create a better health experience for all consumers.

Join our winning culture and help transform Medicare for the millions of people who rely on its services.

• Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire
• Short- and long-term disability benefits
• 401(k) plan with company match and immediate vesting
• Free telehealth benefits
• Free gym memberships
• Employee Incentive Plan
• Employee Assistance Program
• Rewards and Recognition Programs
• Paid Time Off and Paid Sick Leave

Under limited direction, this position is responsible for research and response to all correspondence directed to the Contractor Medical Directors, those of a clinical nature, or related to the functions within the Medical Affairs department. This position is responsible for coordination and hosting of meetings with stakeholders, Medicare providers, various associations and societies, clinical experts, industry, subject matter experts, the Contractor Advisory Committee and the Open Meetings.

This position is also responsible for processing of Investigational Device Exemption requests.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.

• Independently research and respond in a professional and comprehensive manner to internal and external inquires received by the Contractor Medical Directors (CMDs), of a clinical/medical nature, and regarding any of the tasks performed within the Medical Affairs department including Local Coverage Determination (LCD) and Article development and maintenance, local claims processing edits, as well as local pricing and fee development.
• Responsible for comprehensive Medicare research and thorough understanding of the rules and regulations to develop answers to the most challenging correspondence received from providers and stakeholders. Research areas include but are not limited to the following:
  • Medicare rules and guidance
  • Specific claim research (Medicare Claims System and Federal Intermediary Standard System)
  • Local coverage
  • Billing and coding
  • Payment and fees
• Responsible for comprehensive responses via email or conference call to provide accurate and timely information and education to customers.
• Collaboration with the Medical Policy team to ensure proper handling of New LCD Requests and LCD Reconsideration Requests.
• Tracking and monitoring of correspondence and related tasks to ensure timely and accurate completion per CMS requirements.

• Represent the company to clinical experts, stakeholders, and interested parties in the Company's jurisdictions who work with the Medical Policy team, CMDs, and Pricing Consultants by coordinating and hosting teleconferences and webinars including the following:
  • Contractor Advisory Committee Meeting (CAC) — Host of the jurisdictional evidentiary meeting including maintenance of the CAC roster, conflict of interest disclosures and other forms, education and various communications
  • Open Meeting — Host of the jurisdictional LCD comment meeting including handling of various presenter forms,…