Medical Equipment Benefit Project Manager

  • location: Minneapolis, MN
  • type: Contract
  • salary: $58 - $70 per hour
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job description

Medical Equipment Benefit Project Manager

job summary:
Now Hiring: Medical Equipment Benefit Manager

Are you ready for a life-changing opportunity? Are you ready to learn and work with a Top Fortune 500 company? Then embrace this rewarding opportunity NOW!

Apply today because openings are limited!!

Overview:

Senior Consultant, Durable Medical Equipment Benefit Manager

(100% Remote, USA)

Potential for up to 20% domestic travel

Medical Benefit Management

This position is responsible for supporting the development of a management program for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS).

Responsibilities:

  • Serving as subject matter expert for DMEPOS for multiple cross functional teams executing on the program. Necessary expertise includes:
  • being familiar with CMS guidelines, NCDs, LCDs, and appropriate guidelines (InterQual, Milliman and Robbins) used in medical necessity determinations;
  • fluency with understanding and logically breaking down DMEPOS benefit design for individuals less familiar with it
  • familiarity with manufacturers and distributors in the outpatient DMEPOS space
  • familiarity with billing procedures for DMEPOS
  • Participate in or lead workstreams in partnership with some of or all of the following cross-functional teams:
  • technology teams, to design supporting IT to meet needs of users;
  • healthcare economic and finance teams, to predict and evaluate value delivered
  • network contracting, to support contract design, network design, and as needed supplier negotiations
  • operations, to help streamline and simplify job aids, design operational workflows, design staffing for all job functions
  • medical policy and clinical teams, to jointly design best-in-class reimbursement policy and medical policy guidance
  • sales and growth teams, to craft value stories for individual payer clients and join client sales conversations
  • This individual will report to the DMEPOS Product Director.
Minimum Experience Required:

  • Knowledge of applicable state and federal laws, URAC and NCQA standards.
  • HCPCS Codes as well as familiarity with Durable Medical Equipment
  • Functional knowledge of managed care/insurance industry standard practices, e.g. provider billing practices, claims payments, prior authorization/utilization management criteria, etc.
  • Experience with various insurance products including Managed Care, Medicare Advantage, Medicare and Medicaid desired
  • Functional knowledge of health plan contract language, certificates of coverage, schedule of benefits, etc.
  • Ability to navigate multiple platforms that contain provider data, member information, and authorizations.
Required Skills:

  • Critical thinking
  • Ability or experience working across a matrix organization
  • Ability to develop and foster internal and external relationships
  • Ability to work effectively in a remote work environment
  • Ability to maintain confidentiality concerning financial and customer transactions
  • Enthusiasm to innovate and take a 'start up' mindset
  • Ability to work autonomously
  • Dedication to UHG Cultural Values (Innovation, Relationships, Performance, Integrity, Compassion)
  • Responsible for the coordination and completion of projects across various functional areas. Ensures projects are completed on time and in scope
  • Ability to work and execute successfully on complicated projects
Additional Valued Experience:

  • Clinical experience: MD, Nurse, or Physical Therapist with DME experience. Board Certification Physical Medicine and Rehabilitation. Current, valid and unrestricted license in the United States
  • Coding: Medical coding knowledge, certification in ICD 9, ICD 10 coding IT/Systems: Knowledge of medical claims systems and database applications. Experience working with IT teams following an Agile Product Development Methodology
  • Communication and presentation skills to C suite
Location: Eden Prairie, MN

If you would like to be a valued employee to their organization, please email qualified resumes to:

Amanda Nordmann

amanda.nordmann@randstadusa.com

Phone: 612.313.7980

 
location: Minneapolis, Minnesota
job type: Contract
salary: $58 - 70 per hour
work hours: 8 to 5
education: Master's Degree
experience: 8 Years
 
responsibilities:
Overview:

Senior Consultant, Durable Medical Equipment Benefit Manager

(100% Remote, USA)

Potential for up to 20% domestic travel

Medical Benefit Management

This position is responsible for supporting the development of a management program for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS).

Responsibilities:

  • Serving as subject matter expert for DMEPOS for multiple cross functional teams executing on the program. Necessary expertise includes:
  • being familiar with CMS guidelines, NCDs, LCDs, and appropriate guidelines (InterQual, Milliman and Robbins) used in medical necessity determinations;
  • fluency with understanding and logically breaking down DMEPOS benefit design for individuals less familiar with it
  • familiarity with manufacturers and distributors in the outpatient DMEPOS space
  • familiarity with billing procedures for DMEPOS
  • Participate in or lead workstreams in partnership with some of or all of the following cross-functional teams:
  • technology teams, to design supporting IT to meet needs of users;
  • healthcare economic and finance teams, to predict and evaluate value delivered
  • network contracting, to support contract design, network design, and as needed supplier negotiations
  • operations, to help streamline and simplify job aids, design operational workflows, design staffing for all job functions
  • medical policy and clinical teams, to jointly design best-in-class reimbursement policy and medical policy guidance
  • sales and growth teams, to craft value stories for individual payer clients and join client sales conversations
  • This individual will report to the DMEPOS Product Director.
 
qualifications:
Minimum Experience Required:

  • Knowledge of applicable state and federal laws, URAC and NCQA standards.
  • HCPCS Codes as well as familiarity with Durable Medical Equipment
  • Functional knowledge of managed care/insurance industry standard practices, e.g. provider billing practices, claims payments, prior authorization/utilization management criteria, etc.
  • Experience with various insurance products including Managed Care, Medicare Advantage, Medicare and Medicaid desired
  • Functional knowledge of health plan contract language, certificates of coverage, schedule of benefits, etc.
  • Ability to navigate multiple platforms that contain provider data, member information, and authorizations.
Required Skills:

  • Critical thinking
  • Ability or experience working across a matrix organization
  • Ability to develop and foster internal and external relationships
  • Ability to work effectively in a remote work environment
  • Ability to maintain confidentiality concerning financial and customer transactions
  • Enthusiasm to innovate and take a 'start up' mindset
  • Ability to work autonomously
  • Dedication to UHG Cultural Values (Innovation, Relationships, Performance, Integrity, Compassion)
  • Responsible for the coordination and completion of projects across various functional areas. Ensures projects are completed on time and in scope
  • Ability to work and execute successfully on complicated projects
Additional Valued Experience:

  • Clinical experience: MD, Nurse, or Physical Therapist with DME experience. Board Certification Physical Medicine and Rehabilitation. Current, valid and unrestricted license in the United States
  • Coding: Medical coding knowledge, certification in ICD 9, ICD 10 coding IT/Systems: Knowledge of medical claims systems and database applications. Experience working with IT teams following an Agile Product Development Methodology
  • Communication and presentation skills to C suite
Location: Eden Prairie, MN

If you would like to be a valued employee to their organization, please email qualified resumes to:

Amanda Nordmann

amanda.nordmann@randstadusa.com

Phone: 612.313.7980

 
skills: Project Management, Medical Terminology, Analysis
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

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