Medical Affairs Coordinator

2 weeks ago


West Columbia, United States Professional Management Enterprises Full time

Job Description

Job Description

Seeking a

RN

to function as a

Medical Affairs Coordinator . This position if fully remote. The schedule is M-F, 9am-5pm DUTIES: Ensures that the Local Coverage Determination (LCD) process adheres to contract instructions. Creates, implements, and maintains educational tools to help providers reduce the submission of claims for non-covered services and reduce the claims payment error rate. Provides clinical expertise, research, and judgment to develop Local Coverage Determinations (LCDS). Provides clinical input for internal requests. Serves as reviewer to determine inter-rater reliability.

Required Skills and Abilities: Knowledge of managed care or medical claims payment policy issues. Excellent verbal and written communication skills. Excellent customer service, organizational, presentation, analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion.

Required Software and Tools: Microsoft Office. Working knowledge of database software. Knowledge of

government/healthcare

programs and contracts laws, regulations, coding, and approval practices. Knowledge of corporate

administrative/medical

policy for all lines of business. Knowledge of guidelines, benefits, and coverage for all lines of business. Preferred Software and Tools:

Working knowledge of Microsoft Access or other database software, DB2 and Easytrieve.

EDUCATION/REQUIREMENTS: Bachelor's degree - Nursing or other health related field. OR, Associate's degree in Nursing with an active unrestricted RN license from the United States and in the state of hire. Required Work Experience: 5 years clinical experience in medical insurance, managed care, case management, or claims management, or a combination of these areas. Required License and Certificate: An active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC). Company Description Professional Management Enterprises is a minority and veteran owned business that partners with major healthcare providers to find quality employees and thrives on helping people find positions that exceeds their expectations.

Company Description

Professional Management Enterprises is a minority and veteran owned business that partners with major healthcare providers to find quality employees and thrives on helping people find positions that exceeds their expectations. #J-18808-Ljbffr



  • West Columbia, United States Spectraforce Technologies Full time

    Job Title: Medical Affairs Coordinator Location: Columbia, SC 29203. (Remote) Duration: 12 months assignment with possible conversion Shift: Mon - Fri, 9am to 5pm EST. May require additional time/effort when needed Payrate: $38/hr Note: 2-3 rounds of interviewsSummary: Ensures that the Local Coverage Determination (LCD) process adheres to contract...


  • West Columbia, United States LanceSoft Full time

    •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...

  • Psychiatrist/Medical

    4 weeks ago


    Columbia, SC, United States Department of Veteran Affairs Full time

    The WJB Dorn VA Medical Center located in Columbia, SC is recruiting for BC/BE Psychiatrists.   Provide general clinical psychiatric services to Veterans and including on-call services General psychiatric care of adult Veterans and may include, but are not limited to, conducting diagnostic evaluations, psychiatric consults, medication management, and...


  • Columbia, South Carolina, United States Federal Maritime Commission Full time

    Ideal Candidate: The ideal candidate has experience as a writer-editor and has executed communication products for a diverse audience. This person has strong attention to detail, an eye for consistent messaging, and proficiency with grammar and editorial conventions. The ideal candidate works successfully in a collegial team-oriented setting with an...


  • District Of Columbia, United States Goldbelt Incorporated Full time

    Overview Goldbelt C6 offers research and development, engineering, and logistics services that enhance and enlarge customers' operations. C6's expertise is focused on integrating C6ISR and scientific, engineering, and technical support for various government partners. The experts at C6 are research and data-driven and ready to create custom...


  • District Of Columbia, United States Goldbelt Incorporated Full time

    Overview Goldbelt C6 offers research and development, engineering, and logistics services that enhance and enlarge customers' operations. C6's expertise is focused on integrating C6ISR and scientific, engineering, and technical support for various government partners. The experts at C6 are research and data-driven and ready to create custom...


  • District of Columbia, United States Goldbelt Inc Full time

    Goldbelt C6 offers research and development, engineering, and logistics services that enhance and enlarge customers' operations. C6's expertise is focused on integrating C6ISR and scientific, engineering, and technical support for various government partners. The experts at C6 are research and data-driven and ready to create custom...


  • Columbia, South Carolina, United States Citi Full time

    Job Description:The Latin America Government Affairs position is a value-added resource to business and corporate functions and with country heads at the local and regional level. The role supports the engagement with governments in LATAM and helps to inform the firm of political, legislative and regulatory actions; assesses the impact of potential actions...


  • Columbia, United States Citi Full time

    Job Description: The Latin America Government Affairs position is a value-added resource to business and corporate functions and with country heads at the local and regional level. The role supports the engagement with governments in LATAM and helps to inform the firm of political, legislative and regulatory actions; assesses the impact of potential actions...


  • West Lafayette, United States RTI Surgical Inc Full time

    Location: Onsite in West Lafayette, IN While this is intended to be an accurate reflection of the current job, it is not necessarily an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. RTI Surgical, Inc., reserves the right to revise the job or require that other or different tasks are...


  • District of Columbia, United States Federal Maritime Commission Full time

    Ideal Candidate: The ideal candidate has experience as a writer-editor and has executed communication products for a diverse audience. This person has strong attention to detail, an eye for consistent messaging, and proficiency with grammar and editorial conventions. The ideal candidate works successfully in a collegial team-oriented setting with an...


  • West Lafayette, United States RTI Surgical Inc Full time

    Job DescriptionJob DescriptionLocation: Onsite in West Lafayette, IN While this is intended to be an accurate reflection of the current job, it is not necessarily an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. RTI Surgical, Inc., reserves the right to revise the job or require that...


  • Columbia, United States Medical Careers Institute Full time

    Overview This position is based at our Columbia, SC campus location. Transform your Career at ECPI University Since 1966, ECPI University's employees have been dedicated to helping students achieve their academic and career goals through our unique education model. Our culture is to prioritize our students' success through the support of our dynamic team...

  • Practical Nurse

    3 weeks ago


    Columbia, South Carolina, United States Department Of Veterans Affairs Full time

    Summary This is a general announcement for the LPN position at the William Jennings Bryan Dorn Veterans Affairs Medical Center. Positions available can be for any unit/service of the hospital and will be discussed during your interview.This is an open continuous announcement accepting application until September 30, 2024. Qualified applicants will be...

  • Practical Nurse

    4 weeks ago


    Columbia, United States Department Of Veterans Affairs Full time

    Summary This is a general announcement for the LPN position at the William Jennings Bryan Dorn Veterans Affairs Medical Center. Positions available can be for any unit/service of the hospital and will be discussed during your interview. This is an open continuous announcement accepting...


  • Columbia, South Carolina, United States University of Missouri Full time

    The University of Missouri Office of Student Engagement is seeking a collaborative, student-centered professional to fill the role of Coordinator for Student Involvement and serve as the primary advisor for programs and services associated with the Organization Resource Group (ORG). Programs and services include, but are not limited to, student organization...

  • Surgical Coordinator

    2 weeks ago


    Columbia, United States Mercy Medical Center Full time

    Summary As a Surgical Coordinator at Mercy Medical Center, you'll play a pivotal role in facilitating smooth and efficient surgical operations within our gynecology department. You'll be responsible for coordinating surgical schedules, managing patient appointments, and ensuring all necessary authorizations are obtained. This is a dynamic role that...


  • Columbia, United States Professional Management Enterprises Full time

    Job DescriptionJob DescriptionSeeking a Credentialing Specialist to be responsible for the completion of the initial credentialing and re-credentialing process of providers to the network. MUST Reside in SC. Fully remote after onsite training in Columbia, SC. The schedule is M-F 8:00a-4:30p.Job Essentials:Maintains credentialing database and ensures...


  • West Columbia, United States Sharing Hope SC Inc Full time

    Clinical Donation Coordinator I Job Details Job Location Columbia - West Columbia, SC Description Summary The Clinical Donation Coordinator (CDC I) responds to referrals of potential organ donors and is responsible for evaluating and setting the plan for medical management for optimal organ function to obtain and assure effective organ donation. Essential...


  • West Columbia, United States We Are Sharing Hope SC Full time

    Job DetailsJob Location Columbia - West Columbia, SC DescriptionSummary The Clinical Donation Coordinator (CDC I) responds to referrals of potential organ donors and is responsible for evaluating and setting the plan for medical management for optimal organ function to obtain and assure effective organ donation. Essential Duties & Responsibilities ...