MAXIMUS

  • Policy Analyst - SME - Remote Opportunity

    Job Locations US-NY-Pittsford
    Posted Date 2 weeks ago(4/4/2018 11:53 AM)
    Requisition ID
    2018-30873
    # of Openings
    1
    Job Function
    Appeals
    Job Schedule
    Regular Full-Time
  • Project/Position Introduction

    MAXIMUS is a leading operator of government health and human services programs and has partnered with state, federal and local governments to provide critical, high quality health and human service programs to a diverse array of communities. Operating under MAXIMUS’s founding mission of Helping Government Serve the People® since 1975, MAXIMUS Federal Services is entirely focused on helping government agencies run programs cost-effectively and serve program constituents with improved outcomes. By being a responsible steward for government programs, we help the federal government deliver on its promises through our people, process and technology. Our focus is always on outcomes and results that connect citizens more effectively with government services.

    Overview

    REMOTE OPPORTUNITY - The Analyst Policy SME is a subject matter expert on Medicare appeals and Durable Medical Equipment coverage policies.  The SME is responsible for researching issues related to Medicare appeals, developing and maintaining appeal resources, and for interacting with Appeal Associates/Consultants to ensure proper understanding of Medicare rules.  At times the SME will also assists with adjudication of appeals

    Responsibilities

    • Identify the legal, factual and policy issues to be addressed in Medicare administrative appeals. 
    • Research issues and write job aides, and maintain subject matter expertise in Medicare DME coverage policies
    • Evaluate appeals decision, advise on the interpretation and application of Medicare laws and regulations and provide strategies to promote consistency in the appeals process and reduce the number of claim reversals
    • Conduct initial and routine training with Appeal Associate/Consultants on policy related subjects and/or coverage rules
    • Maintain updated library of adjudication practices
    • Review and assess quality of appeal outcomes
    • Coordinate Medicare contractors’ efforts to ensure CMS perspective is represented effectively at ALJ hearings.
    • Perform other duties as assigned by leadership

    The Ideal Candidate will Possess the Following Additional Education and Experience

    • Bachelor’s degree preferred, but can be substituted with related work experience, Medicare experience and/or appeals experience, or the combination of both
    • Demonstrated excellent research and writing skills; subject matter expertise in Medicare law and policy or the ability to learn quickly
    • Ability to build and maintain constructive relationships with management, Medicare contractors and clients. 7 plus years’ experience, government agency or corporation environment, or applicable experience

    • Experience in Medicare work Part A, B and DME; three years’ experience with a Medicare program, experience in Medicare appeals or other appeals programs is preferred

    EEO Statement

    EEO Statement
    Active military service members, their spouses, and veteran candidates often embody the core competencies MAXIMUS deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you

    A committed and diverse workforce is our most important resource.

    MAXIMUS is an Affirmative Action/Equal Opportunity Employer.

    MAXIMUS provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.

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