US Tech Solutions • Houston, TX 77007
Job #2692942605
Job Description:
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. The error rate is a factor in awarding and renewing Medicare/other contracts.
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 with other interdepartmental staff in appropriate coding and reimbursement guidelines to ensure coordination and compliance.
Provides clinical input for internal requests. Serves as reviewer to determine inter-rater reliability.
Experience:
Certification
Skills:
Knowledge of managed care or medical claims payment policy issues. Working knowledge of word processing, spreadsheet software.
Microsoft Office. Preferred Skills and Abilities: Working knowledge of database software.
Knowledge of government/healthcare programs and contracts laws, regulations. Knowledge of government/healthcare programs and 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. Work Environment: Typical office environment. Some travel required.
Education
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit ~~~ .
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
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