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Posted : Wednesday, June 05, 2024 06:28 AM
* Position is eligible for Remote / Work from Home opportunity *
Department: Medical Policy
Telecommuting Eligible: Yes
Job Grade: N14
Notice of Collection & Privacy Policy for Applicants Residing in California: California Applicant Privacy Policy | Noridian (noridiansolutions.
com) Job Title Medical Policy Spec II Job Summary The Medical Policy Specialist (MPS) provides administrative support and research as part of the medical policy function of Noridian.
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 Key Duties/Responsibilities/Accountabilities Handles day-to-day medical related policy communications with internal Noridian 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 Noridian medical policy meetings and prepares minutes (e.
g.
Internal Policy, medical policy, and team meetings) Assists medical directors and medical policy staff with researching claim 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 Functions as a liaison and provides assistance to other departments Provides training and assistance to Medical Policy Spec Level I staff as needed Assist the Medical Policy Spec Level III staff by providing back-up assistance as needed Coordinates and attends the Contractor Advisory Committee meetings and Open Public meetings Revises and completes LCDs and coverage articles for LCDs and NCDs in the Medicare Coverage Database (MCD) Coordinates and distributes all medical policy staff agendas and minutes Attends designated meetings and completes assignments Drafts letters for medical directors for the LCD reconsideration responses SharePoint designer for the team Conducts peer reviews for team processes Performs Investigational Device Exemption (IDE) claims processing Non-Essential Duties and Functions Other duties as assigned Minimum Qualifications Associate degree in Medical Coding, Medical Assistance, Medical Secretary, or closely related field CPC, CPC-H, or CPSC-H certification fulfills the Associate degree requirement as may two or more years of clearly successful coding experience in one who is working on but not yet completed certification 3 years' experience in Medicare, clinical health care, claims processing or other clinical administrative support Understanding of provider and hospital procedure and diagnosis coding Experience using Microsoft Office Suite applications (Word, Excel, Outlook and PowerPoint) Familiar with federal, state, and Medicare regulation, CMS guidance, and other applicable resources relating to medical policy and other health care industry standards Basic working knowledge of the Medicare Coverage Database (MCD) and the Medicare website Preferred Qualifications 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 Understanding of MCS, FISS, and CWF system editing SharePoint skills Accounting knowledge and experience Presentation skills Environment and Cognitive/Physical Demands Office Environment Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve Requires prolonged sitting and telephone use Requires the use of office equipment such as computer terminals, telephones, copiers and printers Infrequent lifting to 15ounds Infrequent stooping Travel up to 25% 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 management.
Total Rewards Package: Health, Dental and Vision Insurance, Voluntary Insurance Plans, Health Savings and Flexible Spending Accounts, 401k and Company Match, Company-paid Life Insurance, Education Assistance Program, Paid Sick Leave, Paid Holidays, Increasing PTO Accrual Plan, Medical/Parental/Disability Leave, Workers Compensation, Retiree Benefits, Severance Package, Employee Assistance Program, Financial and Health Wellness Benefits, Casual Dress, Open Office Setting, and Online Learning System.
CMS Access Compliance and Regulation Contingency Statement Some positions require compliance with (i) federal and agency specific regulations and related clauses included in Noridian's prime contracts with the Government, (ii) background checks, and (iii) eligibility for a government-issued identification card.
Equal Employment Opportunity Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities as well as Sexual Orientation or Gender Identity.
Below is the salary range for potential new hires.
Salary Range: $19.
05 – $31.
34 Other Compensation: Incentive Plan Lifestyle Benefit: $50/month This job will be closed 12/8/2023 at 8:00AM CST.
No further applications will be considered.
Education Required Associates or better in Other Licenses & Certifications Required CPC, CPC-H, or CPSC-H Preferred Cert Professional Coder Cert Prof Coder-Hosp Cert Prof Spec Coder-Hosp Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant.
However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information.
41 CFR 60-1.
35(c)
com) Job Title Medical Policy Spec II Job Summary The Medical Policy Specialist (MPS) provides administrative support and research as part of the medical policy function of Noridian.
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 Key Duties/Responsibilities/Accountabilities Handles day-to-day medical related policy communications with internal Noridian 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 Noridian medical policy meetings and prepares minutes (e.
g.
Internal Policy, medical policy, and team meetings) Assists medical directors and medical policy staff with researching claim 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 Functions as a liaison and provides assistance to other departments Provides training and assistance to Medical Policy Spec Level I staff as needed Assist the Medical Policy Spec Level III staff by providing back-up assistance as needed Coordinates and attends the Contractor Advisory Committee meetings and Open Public meetings Revises and completes LCDs and coverage articles for LCDs and NCDs in the Medicare Coverage Database (MCD) Coordinates and distributes all medical policy staff agendas and minutes Attends designated meetings and completes assignments Drafts letters for medical directors for the LCD reconsideration responses SharePoint designer for the team Conducts peer reviews for team processes Performs Investigational Device Exemption (IDE) claims processing Non-Essential Duties and Functions Other duties as assigned Minimum Qualifications Associate degree in Medical Coding, Medical Assistance, Medical Secretary, or closely related field CPC, CPC-H, or CPSC-H certification fulfills the Associate degree requirement as may two or more years of clearly successful coding experience in one who is working on but not yet completed certification 3 years' experience in Medicare, clinical health care, claims processing or other clinical administrative support Understanding of provider and hospital procedure and diagnosis coding Experience using Microsoft Office Suite applications (Word, Excel, Outlook and PowerPoint) Familiar with federal, state, and Medicare regulation, CMS guidance, and other applicable resources relating to medical policy and other health care industry standards Basic working knowledge of the Medicare Coverage Database (MCD) and the Medicare website Preferred Qualifications 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 Understanding of MCS, FISS, and CWF system editing SharePoint skills Accounting knowledge and experience Presentation skills Environment and Cognitive/Physical Demands Office Environment Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve Requires prolonged sitting and telephone use Requires the use of office equipment such as computer terminals, telephones, copiers and printers Infrequent lifting to 15ounds Infrequent stooping Travel up to 25% 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 management.
Total Rewards Package: Health, Dental and Vision Insurance, Voluntary Insurance Plans, Health Savings and Flexible Spending Accounts, 401k and Company Match, Company-paid Life Insurance, Education Assistance Program, Paid Sick Leave, Paid Holidays, Increasing PTO Accrual Plan, Medical/Parental/Disability Leave, Workers Compensation, Retiree Benefits, Severance Package, Employee Assistance Program, Financial and Health Wellness Benefits, Casual Dress, Open Office Setting, and Online Learning System.
CMS Access Compliance and Regulation Contingency Statement Some positions require compliance with (i) federal and agency specific regulations and related clauses included in Noridian's prime contracts with the Government, (ii) background checks, and (iii) eligibility for a government-issued identification card.
Equal Employment Opportunity Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities as well as Sexual Orientation or Gender Identity.
Below is the salary range for potential new hires.
Salary Range: $19.
05 – $31.
34 Other Compensation: Incentive Plan Lifestyle Benefit: $50/month This job will be closed 12/8/2023 at 8:00AM CST.
No further applications will be considered.
Education Required Associates or better in Other Licenses & Certifications Required CPC, CPC-H, or CPSC-H Preferred Cert Professional Coder Cert Prof Coder-Hosp Cert Prof Spec Coder-Hosp Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant.
However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information.
41 CFR 60-1.
35(c)
• Phone : NA
• Location : 901 40th Street South, Fargo, ND
• Post ID: 9004018140
