Neil Hoosier & Associates, Inc.
Location
Owings Mills, MD | United States
Job description
Neil Hoosier & Associates, Inc. (NHA) is a small, SBA 8(a) certified and minority-owned business built on a tradition of reliability, accuracy, and responsiveness to the needs of our clients. We have delivered over 20 years of top-notch performance within the public sector, particularly for the Centers for Medicare & Medicaid Services (CMS), as well as for consulting firms, insurers, employers, and healthcare companies. Our talented staff offers business and IT solutions to Federal, State, and commercial organizations within the framework of a process improvement culture. We leverage our unrivaled expertise, extensive capabilities, and innovative solutions to ensure that our clients achieve their goals while saving money in the process.
The Physician Reviewer role is ideal for someone who wants to work a few hours a month (anticipated to be 4-5 hours) without a set schedule. We're okay with this being a supplemental role as long as COI is a non-issue. This is a fully remote opportunity, and the targeted hourly rate range is $165-180, commiserate with Medicare claims experience.
Summary: Provide clinical expertise, recommendations, and insights to effectively assist with the evaluation and oversight of the accuracy, timeliness, and quality of QIC and MAC appeal decisions that support the Medicare appeals program.
Responsibilities and Duties: The following reflects NHA management’s definition of essential functions for this job but does not restrict the tasks that may be assigned. NHA management may assign or reassign duties and responsibilities to this job at any time due to reasonable accommodation or other reasons.
- Participates in the process to ensure the appropriateness and quality of medical care and medically related care.
- Conducts medical analysis of complex claims files and appeals ensuring that paperwork and the filings follow compliance procedures established by government regulations and laws.
- Stays informed concerning the latest research and policy developments in the medical profession.
- Applies deep expertise to deliver advice, thought leadership, and targeted deliverables to support program objectives.
- Uses deep understanding of a particular process, function, or technology and possesses extensive knowledge in one or more functional areas.
- Ensures the facts and details are correct so that the project's/program's deliverable(s) will meet the needs of the stakeholders, policies, standards, and best practices.
- Makes recommendations and advises on areas relative to their expertise.
Qualifications - Doctor of Medicine (MD) and board-certification.
- At least 25 years of professional healthcare experience.
- Extensive knowledge of healthcare policy, specifically as it relates to Medicare appeals.
- Working knowledge and understanding of Medicare regulations.
- Clear understanding of regulatory systems and processes that affect health care systems.
- Investigative and problem-solving skills.
- Demonstrates strong writing and oral communication skills.
- Demonstrated ability to deal with confidential information.
- Proficiency with Microsoft Outlook, Excel and Microsoft Office.
Employees that are hired for a position on a Federal Government contracts may be subject to U.S. Office of Personnel Management (OPM) background checks at a Public Trust, or higher, level. More information can be found here:
NHA is a state and federal government contractor; all employees must be legally authorized to work in the United States. NHA does not provide sponsorship at this time.
NHA is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability or any other basis protected by law.
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