NCI: As the Medical Review Supervisor (Medical Reviewer Lead ) for AdvanceMed, a subsidiary of NCI, you will play an integral role in the success of our growing and vibrant medical review team, focusing on Medicare program integrity. You will use your leadership and management skills to oversee the day to day functions of the department, under the direction of the Medical Review Manager. In this important role, you will apply your Medicare expertise in assessing review determinations and in collaborative efforts with the rest of our benefit integrity team. You will be a critical contributor in meeting AdvanceMed’s mission, “To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste, and abuse."
Highlights of Responsibilities:
- Performs oversight of prepay and postpay reviews for Benefit Integrity activities.
- Ensures that claim reviews meet standards defined by the Statement of Work, the Program Integrity Manual, and CMS directives and regulations pertaining to Medical Review.
- Provides resource and research assistance to the Medical Review team, Benefit Integrity and Data Analyst team members.
- Communicates with Medicare Administrative Contractors (MAC) staff regarding medicare claims payment issues.
- Determines necessary education and training for the department and ensures that it is provided to, and attended by, the MR staff.
- Produces and submits required reports according to established content and timeframes nsures that MR staff accurately bill time to the appropriate contract(s) and activities.
- Coordinates, tracks, and analyzes appeals activities and results.
- Develops, implements, and ensures department compliance with the quality management system and ISO requirements.
- Effectively communicates with the customer, stakeholders and employees.
- Performs other projects and responsibilities as assigned by the Medical Review Manager or Program Managers.
Preferred Education and Experience:
- Must be a Registered Nurse (RN) or Registered Physical or Occupational Therapist, with an active license in the state of residence.
- At least five (5) years of clinical experience or equivalent experience in the Medical Review field.
- At least five (5) years of utilization/quality assurance review and ICD-9-CM/CPT coding experience with DRG codes.
- Knowledge of and the ability to correctly identify Medicare coverage guidelines.
- Proficiency in Microsoft Office and Internet applications at an intermediate level.
- Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program; and must have no conflict of interest (COI) as defined in § 1154(b)(1) of the Social Security Act.
- Must have and maintain a valid driver’s license issued by the state of residence.
- Minimum three years in a supervisory/leadership/management position.
- Experience managing and prioritizing multiple, and changing tasks.
- Ability to work with others in a collaborative team environment.
- Excellent interpersonal, problem solving and communication skills.
- Minimum of four years experience in medical/utilization review or fraud investigation.
- For Registerd Nurse applicants, preference given to candidates that have a Bachelor of Science Degree in Nursing.
At NCI, we’re more than just a paycheck…
We offer significant opportunity for growth at NCI – Adding more and more employees and company locations nationwide, we continue to seek top talent to ensure our path of innovation, growth and unmatched customer experience. We reward our employees with competitive compensation, flexible time off, retirement plan with company match and much more…
MEDICAL/DENTAL/VISION PROGRAMS - NCI offers three medical plan options to meet the personal health needs and budgets of our full-time employees and their families. All plans provide our employees and their eligible dependents with major medical and prescription drug coverage. The dental plan provides coverage options so as to ensure our full-time employees and their eligible dependents are able to follow a regularly scheduled program of dental care with their providers of choice. A vision maintenance plan offers a cost-savings option for our full-time employees and their families in need of comprehensive annual eye exams, prescription glasses, and contact lenses.
STOCK & WEALTH - NCI’s 401(k) Profit Sharing Plan is eligible to all full-time and regular part-time employees. Employees may elect to have contributions invested in any of the 15 different investment funds, five retirement-date-based funds, or three different portfolio options available under the plan. The company matching contribution is equal to 50% of employee elected pre-tax contributions up to 6% of eligible pay, subject to the IRS maximum.
LIFE INSURANCE - NCI provides company paid Basic Life/ AD&D Insurance Coverage. The basic coverage benefit is equal to one times (1X) an employee's annual base salary. Employees may also opt for a generous flat rate insurance coverage. For coverage above the company-provided limits, employees may purchase supplemental insurance coverage for themselves and their family members.
WORK/LIFE BALANCE - All employees are eligible for additional programs including Paid Time Off (PTO).
- Flexible Spending Programs
- Employee Assistance Program (EAP) for employees and their immediate family
- Health Club Reimbursement through NCI’s Wellness Program
It is your turn… Choose your career path and become part of the NCI team where you will be valued for your unique skills and capabilities and where you will be rewarded for key contributions to NCI and our customers.
Make the commitment and take the next step towards joining the NCI Team. Our application process will take approximately 5-10 minutes to complete.
If you do not meet the minimum qualifications for this position, please review our current openings now and in the future. Thank you for your interest in NCI!
It is the policy of NCI to provide equal opportunity in recruiting, hiring, training, and promoting individuals in all job categories without regard to race, color, religion, national origin, gender, age, sexual orientation, disability or veteran status.
The information above has been designed to indicate the general nature and level of work performed by employees within the classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees assigned to this position.
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