Medical Affairs Research Anlst - Novitas

SUMMARY STATEMENT
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.

 

ESSENTIAL RESPONSIBILITIES
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.

Correspondence: (70%)
* 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:
o Medicare rules and guidance
o Specific claim research (Medicare Claims System and Federal Intermediary Standard System)
o Local coverage
o Billing and coding
o 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.

Meetings: (20%)
* 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:
o 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
o Open Meeting -- Host of the jurisdictional LCD comment meeting including handling of various presenter forms, education and communications
o Informal Meeting -- education and communication
o Any interested party who wants to speak to a Contractor Medical Director
o Stakeholder meetings regarding the LCD and Article process
o Stakeholder meetings regarding local fee development or revision
o National workgroup meetings

Web postings, Newsletters, Frequently Asked Questions (FAQs): (5%)
* Development and maintenance of education and materials pertinent to the various functions within Medical Affairs including but not limited to LCDs and Articles, CAC and Open Meetings, local pricing, and Investigational Device Exemptions.

Processing of Investigational Device Exemption (IDE) requests: (5%)
* Independently review IDE requests from customers to ensure completeness and accuracy
* Educate customers on the request and review process
* Respond accurately and timely to all requests
* Update the claims processing system to allow proper processing of claims submitted by approved providers
* Tracking and monitoring of IDEs and related tasks to ensure timely and accurate completion per CMS requirements

Performs other duties as the supervisor may, from time to time, deem necessary.

 

REQUIRED QUALIFICATIONS
* High School Diploma or GED
* 4 year's related work experience in Medicare operations, claims review, case review, education, and/or medical & payment policy including Medicare and health insurance coding experience (CPT, HCPCS, ICD-10, etc.)
* Demonstrated proficiency in Multi-Carrier System (MCS) and Federal Intermediary Standard System (FISS) research
* Demonstrated proficiency in Medicare guidelines and related research
* Demonstrated proficiency using Microsoft applications: Word, Excel, PowerPoint
* Demonstrated proficiency with Internet research
* Demonstrated excellent oral and written skills
* Demonstrated excellent organization and tracking skills
* Demonstrated experience and confidence leading a large group meeting with external stakeholders

 

 

PREFERRED QUALIFICATIONS
* Medicare education experience (e.g., Provider Outreach and Education, Critical Inquiries, Targeted Education)
* Proficiency in Medical Terminology

CERTIFICATIONS, LICENSES, REGISTRATIONS
* Certifications: CPC, CEMC, CHC-H, or equivalent

Background Investigation: If you are selected for this position, you must undergo a pre-employment Background Investigation, Drug Screen, and Identity Proofing documentation must be cleared prior to hire. Most positions are subject to additional Identity Proofing, Fingerprinting and additional Background Investigation screening conducted by the Federal Government to be granted Enterprise User Administration (EUA) system logical access after you begin your employment. Your continued employment is contingent upon the outcome of the complete additional screening criteria required for the position which must find that you meet the applicable government customer's requirements (e.g., suitable for access to CMS information and information systems), as well as any additional investigation which may be required throughout your employment. If you are found not suitable, your employment may be subject to corrective action, up to and including immediate termination of employment.

 

Identity Documentation: You must have access to a current and unrestricted REAL ID, U.S. Passport, U.S. Passport Card, Foreign Passport, or U.S. Permanent Residency Documents. Note: Employment Authorization Cards (EAD) are not a substitute for Visas or U.S. Permanent Resident Cards.