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Novitas Solutions, Inc.
- Mechanicsburg, PA / Columbus, GA / Pittsburgh, PA / 2 more...
The Medicare Contractor Medical Director (CMD) provides medical leadership and decision making for Novitas Solutions, Inc. Job duties include but are not limited to Lead Local Coverage Determination (LCD) development and decision making Participate in all phases of LCD development Provide the clinical expertise and data management to effectively focus medical policy and review on identified proble
Posted 1 day ago
STATEMENT This position is responsible for the development and maintenance of Local Coverage Determinations (LCDs) and Local Coverage Articles (Articles) in accordance with the CMS Internet Only Manual, Publication 100 08, Chapter 13. This includes the varied and highly visible requirements of Novitas' current CMS contracts, including the JL and JH MAC contracts, listed below. This position is res
Posted 1 day ago
Novitas Solutions, Inc.
- Mechanicsburg, PA / Jacksonville, FL
STATEMENT The Clinical Review Nurse is responsible for reviewing and making medical determinations as to the validity of health claims and levels of payment in meeting national and local policies as well as accepted medial standards of care. The incumbent applies clinical knowledge to assess the medical necessity, level of services and appropriateness of care which may include cases requiring prio
Posted 2 days ago
STATEMENT This position is responsible for supervising and coordinating the varied and highly visible activities of the Medical Review Department. This includes direct supervision of support staff and clinical professional staff in conducting medical review, provider education and appropriate referrals to the Unified Program Integrity Contractor (UPIC) for potential fraud and abuse related to the
Posted 3 days ago
STATEMENT Responds to Medicare Part A and/or B telephone and/or written inquiries from the Medicare provider community which includes billing offices, medical societies, provider consultants, Managed Care Organizations, attorneys, etc. regarding Medicare coverage guidelines and policies covering a wide range of topics to include provider enrollment, Medicare appeals, debt recovery, claim payment i
Posted 4 days ago
STATEMENT This position is responsible for the integrity of the Medicare Part A and or B Provider files. This position will review applications and ensure compliance with CMS regulations and internal procedures and protocols. ESSENTIAL DUTIES & RESPONSIBILITIES Process submitted provider applications Obtain additional information via telephone or in writing Research and validate information as nee
Posted 13 days ago
STATEMENT Responds to Medicare Part A and/or B telephone and/or written inquiries from the Medicare provider community which includes billing offices, medical societies, provider consultants, Managed Care Organizations, attorneys, etc. regarding Medicare coverage guidelines and policies covering a wide range of topics to include provider enrollment, Medicare appeals, debt recovery, claim payment i
Posted 16 days ago
STATEMENT The ProviderAuditor position is responsible for full or limited audits and interim ratereviews for hospitals, skilled nursing facilities, and clinics as both apreparer and reviewer of work product. ESSENTIALDUTIES & RESPONSIBILITIES To performthis job successfully, an individual must be able to perform each essentialduty satisfactorily. Reasonable accommodations may be made to enableindi
Posted 1 month ago
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