Medical Affairs Coordinator

JOB REQUIREMENTS: Internal Reference Number: R1046743 Summary Ensuresthat the Local Coverage Determination (LCD) process adheres to contractinstructions. Creates, implements, and maintains educational tools tohelp providers reduce the submission of claims for non-covered servicesand reduce the claims payment error rate. The error rate is a factor inawarding and renewing Medicare/other contracts.Description Location Thisrole is remote, full time M-F 8am-5pm. Government Clearance: Thisposition requires the ability to obtain a security clearance, whichrequires applicants to be a U.S. Citizen. SCA Benefit Requirements:BlueCross BlueShield of South Carolina and its subsidiary companies havecontracts with the federal government subject to the Service ContractAct (SCA). Under the McNamara-O'Hara Service Contract Act (SCA),employees cannot opt out of health benefits. Employees will receivesupplemental pay until they are enrolled in health benefits 28 daysafter the hire date. What You Will Do: Provides clinical expertise,research, and judgment to develop Local Coverage Determinations(LCDS)under the direction of medical director. Maintains LCDS once developed.Educates providers and internal customers on LCDS. Communicates withother interdepartmental staff in appropriate coding and reimbursementguidelines to ensure coordination and compliance. Provides clinicalinput for internal requests. Serves as reviewer to determine inter-raterreliability. To Qualify for This Position, You Will Need: RequiredEducation: Bachelor's in a job related field OR Associate's degree inNursing with an active RN license. Required Work Experience: 5 yearsclinical experience in medical insurance, managed care, case management,or claims management, or a combination of these areas. Required Softwareand tools: Microsoft Office Required Skills and Abilities: Knowledge ofmanaged care or medical claims payment policy issues. Working knowledgeof word processing, spreadsheet software. Excellent verbal and writtencommunication skills. Excellent customer service, organizational,presentation, analytical or critical thinking skills. Ability topersuade, negotiate, or influence others.... For full info followapplication link. BlueCross BlueShield of South Carolina and oursubsidiary companies maintain a continuing policy of nondiscriminationin employment to promote employment opportunities for persons regardlessof age, race, color, national origin, sex, religion, veteran status,disability, weight, sexual orientation, gender identity, geneticinformation or any other legally protected status. Additionally, as afederal contractor, the company maintains Affirmative Action programs topromote employment opportunities for minorities, females, disabledindividuals and veterans. It is our policy to provide equalopportunities in all phases of the employment process and to comply withapplicable federal, state and local laws and regulations. APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/7440CC82D1F54C51

Created: 2025-10-04