HP posted a job you might be interested in October 27, 2014 at 06:15PM

HP



Associate Medical Director - Medicare

Greater Boston Area, US - Hospital & Health Care

DME MAC NHIC, Corp. is the Durable Medical Equipment Medicare Administrative Contractor Jurisdiction A Contractor for Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont.



Position Overview



The DME MAC Medical Policy Associate Medical Director will be primarily accountable for the NHIC DME MAC Jurisdiction A’s defense of Medical Review decisions at Administrative Law Judge (ALJ) Hearings. Rules and procedures related to the ALJ hearing process are contained in 42 CFR 405.1000. This position may also support other Medical Policy activities as needed.



Qualifications
Essential Functions may include

• Assessment of notices of hearing to determine which cases should be selected for participation or party status


• Interaction with the Centers for Medicare and Medicaid Services (CMS) on the determination of party status


• Development of Medicare position papers and case files


• Collaboration with other contractors on the manner of participation and coordination on position papers


• Participation or party status at the Administrative Law Judge (ALJ) hearings to present facts of each claim under appeal, the relevant coverage policies and payment requirements, including any clarification required on decisions made earlier in the appeals process.


• Support of other Medical Policy activities unrelated to ALJ hearings as needed.

Prerequisite

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


• Excellent oral and written communications skills


• Excellent customer service, organizational and presentation skills


• Previous Medicare or other health care insurance utilization experience


• Proficient with personal computer use – MS Outlook, Excel and Word


• Excellent collaboration and facilitation skills


• Travel when needed


• Medical policy development would be helpful

No salary provided



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