Associate Medical Director, DME

November 21

🌴 South Carolina – Remote

Although this job is listed in South Carolina, this company may be open to hiring remote in other states.

💵 $206k - $413.5k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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BlueCross BlueShield of South Carolina

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Healthcare Insurance • Insurance • Finance

BlueCross BlueShield of South Carolina is a leading health insurance provider that offers a variety of health plans, including individual and family plans, Medicare options, and group health plans. The organization focuses on providing coverage and resources for members, employers, and healthcare providers, ensuring access to quality healthcare services. With a commitment to promoting healthier lifestyles and supporting community health, BlueCross BlueShield of South Carolina plays a vital role in the healthcare landscape of the region.

10,000+ employees

Founded 1946

⚕️ Healthcare Insurance

💸 Finance

📋 Description

• Provides administrative oversight to the medical staff, analyzes medical review utilization data, researches new medical devices and technology, and acts as a resource to CMS, DMEPOS stakeholders, internal staff, on issues concerning medical device coding and DMEPOS policies. • Oversees coding integrity efforts as well as write and revise coding advisory articles with regard to Medicare policy and procedure. • Supports operations in the form of case review on both medical and regulatory matters. • Develops claim adjudication criteria for situations requiring medical judgment. • Provides input on issues and operational policies, processes, and procedures. • Educates staff and medical community on various aspects of medical policy and program administration. • May develop and update medical policy in consultation with appropriate regulatory personnel, medical consultants, and professional societies. • Develops external relationships with the medical community and serves as liaison between these entities and the contractors. • Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization. • Conducts research into new or controversial medical procedures and technology.

🎯 Requirements

• Doctoral degree Medical Doctor (MD) with current active license to practice medicine. • Five years post graduate experience in direct patient care. • Excellent verbal and written communication skills. • Excellent customer service, organizational, and presentation skills. • Proficiency in spelling, punctuation, and grammar. • Ability to persuade, negotiate, or influence others. • Ability to work as a team member as well as a leader. • Knowledge of medical and utilization review techniques. • Active state medical license and current board certification in a recognized specialty. • Certified Professional Coding is preferred • Knowledge of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) • Experience working in rehabilitation • Three or more years in the healthcare insurance industry, a utilization form or other administrative experience in a health-related field that involved developing coverage and coding policies and guidelines. • Experience involving development of coverage and coding policies and guidelines under a Medicare program contract is preferred.

🏖️ Benefits

• Subsidized health plans • Dental and vision coverage • 401k retirement savings plan with company match • Life Insurance • Paid Time Off (PTO) • On-site cafeterias and fitness centers in major locations • Education Assistance • Service Recognition • National discounts to movies, theaters, zoos, theme parks and more