Medical Affairs Specialist

Company: Palmetto GBA
Location: Cayce
Posted on: June 12, 2021

Job Description:

SummaryDescription 50% Provides clinical expertise, research, and judgment to develop Local Coverage Determinations(LCDS) under the direction of medical director. Maintains LCDS once developed. 35% Educates providers and internal customers on LCDS. Communicates with other interdepartmental staff in appropriate coding and reimbursement guidelines to ensure coordination and compliance. 15% Provides clinical input for internal requests. Serves as reviewer to determine inter-rater reliability.Required Education:Bachelor's degree - Nursing ORAssociate's degree in Nursing with an active RN license, ORGenetic Counselor certification in lieu of the RN license.Required Work Experience:Fiveyears clinical experience in medical insurance, managed care, case management, or claims management, or a combination of these areas.Preferred:Experience/knowledge of laboratory testing and ordering, particularly molecular testing, is highly desired.Required Skills and Abilities:Knowledge of managed care or medical claims payment policy issues.Working knowledge of word processing, spreadsheet software.Excellent verbal and written communication skills.Excellent interpersonal skills.Excellent team player.Comfort with customer service-related activities, including external stakeholder engagement, is required.Excellent customer service, organizational, presentation, analytical or critical thinking skills.Ability to persuade, negotiate, or influence others.Ability to handle confidential or sensitive information with discretion.Required Software and Tools:Microsoft Office.Required License and Certificate:An active, unrestricted RN license from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), ORGenetic Counselor certification in lieu of the RN license.We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.Equal Employment Opportunity StatementBlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.If you need special assistance or an accommodation while seeking employment, please e-mail abilities@bcbssc.com or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

Keywords: Palmetto GBA, Columbia , Medical Affairs Specialist, Other , Cayce, South Carolina