SUPERVISOR, MEDICAL POLICY - REMOTE ARC Group has an immediate opportunity for a Supervisor, Medical Policy! This position is 100% remote. This is a direct hire FTE position with salary, benefits, PTO, 401K, etc. This is a fantastic opportunity to join an established and well-respected organization offering tremendous career growth potential.
At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply.
100% REMOTE!Candidates must have permanent work authorization and work for any employer without sponsorship now or in the future. Third party candidates are not eligible for this role. SUMMARY STATEMENT
Serves as department supervisor and project lead for the Local Coverage Determination (LCD) and Local Coverage Article (Article) development and maintenance function.
ESSENTIAL DUTIES & 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.
Oversees and supervises the related LCD processes such as annual and other mandatory updates (e.g., ICD-10-CM, annual reviews, Current Procedural Terminology (CPT) /Healthcare Common Procedure Coding System (HCPCS updates, Change Request updates, etc.). (40 %)
- Ensures LCDs are accurate and updated in a timely manner, based on national coding guideline changes and CMS requirements.
- Solicits and incorporates feedback and input from CMDs as needed relative to such changes.
Oversees and supervises the policy team responsible for the LCD and Article development function which includes the following tasks (15%):
- Identify and refine list of potential new LCD topics and revisions to existing LCDs based on ever-evolving medical standards, new technology, new drug development and data analysis.
- Directs the Medical Policy Team relative to timelines and deliverables relative to LCD development and revisions, Contractor Advisory Committee (CAC) meeting cycles and CMS requirements.
- Ensures timely completion and delivery of LCD "product" to internal and external stakeholders.
Oversees and supervises the team responsible for the timely and accurate preparation for posting and maintenance of LCDs and Articles on the company website, and separately but identically on the Centers for Medicare and Medicaid Services (CMS) national Medicare Coverage Database (MCD) in accordance with the CMS regulatory guidance and requirements. (15%)
Interfaces with both technical and professional clinical personnel; routinely interacts with all levels of staff within the company as well as entities outside the company. (10%)
- Gains clinical understanding and impacts of LCDs from Contractor Medical Directors (CMDs) internal and external
- Shares LCD impacts with operational areas.
- Educates internal team members on system and processing changes resulting from operationalizing LCDs.
Maintains regular and ongoing communication with external customers and professionals external to the company (e.g., state Medical Societies, other professional societies or organizations, Medicare providers, CMS, and CAC members) to ensure adequate information sharing/education. (5%)
- Works with Provider Outreach and Education (POE) to develop proactive communication and education regarding new and revised LCDs.
- Supervises the team that responds to inquiries from providers and other external entities regarding LCDs.
Maintains regular and ongoing communications with internal customers regarding LCD and Article activities to ensure adequate information sharing/education as appropriate throughout the company. (5%)
- Provides updates to internal and external stakeholders regarding LCD status.
- Provides education to internal stakeholders regarding LCD impact and ensures staff understanding of system and processing implications.
Oversees and supervises the team that is responsible for the department's preparation for the CAC meetings which includes the following tasks: (5%)
- Ensures the coordination of CAC meeting logistics with internal (e.g., POE, contract administration) and external parties (e.g., vendors, hosts, etc.), to include items such as venue, accommodation and technology.
- Ensures timely delivery of CAC materials to all physician members of CAC committee.
- Attends CAC meetings to support CMDs and Medical Affairs Manager.
Assists manager in project management responsibilities, including preparation of workload, budget, and other reporting related to LCDs and Articles. (5%)
- Supports management with monthly workload reporting, budgeting and other administrative tasks as assigned.
- Performs other duties as the supervisor may, from time to time, deem necessary.
REQUIRED QUALIFICATIONS
- High School Diploma or GED
- 3 years' related work experience in clinical field (e.g., Registered Nurse, Physician's Assistant or Physical Therapist), experience in Health or Business Administration, Medicare, health insurance experience in operations, claims review, case review, education, and/or medical and payment policy, and health insurance coding (e.g., ICD-10-CM, CPT/HCPCS).
- 2 years' direct supervisory/project management lead or other leadership experience.
- Proficient in research of the CMS Internet-Only manual (IOM) and national and local coverage decisions
- Comprehensive knowledge of medical, surgical and diagnostic procedures and terminology
- Proficient in MS Office applications and Internet research
- Excellent written and oral communication skills
- Ability to communicate with confidence with other medical professionals, Medical Societies, Medicare providers, CMS and Contractor Advisory Committee (CAC) members
- Professional demeanor and positive approach to work
- Excellent planning, organizing, time and work management skills
- Active and current medical professional licensure - Registered Nurse (RN) license
PREFERRED QUALIFICATIONS
- Direct supervisory experience* 5+ years' related work experience
- Certified Professional Coder (CPC) credential
ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed.
At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know.
Position offered with no fee to candidate.