Medical Consultant (Medicare Programs-Monitoring)

California, MO, United States

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Location: Dartmouth, Nova Scotia, CA, B3J 3C6 Nova Scotia, CA

For over 75 years, Medavie Blue Cross has been a leading health and wellness partner for individuals, employers and governments across Canada. As a not-for-profit organization, we proudly invest in communities to help address some of Canada’s most pressing health care challenges. We are one of Canada's Most Admired Corporate Cultures, one of Canada’s Top 100 Employers, Canada’s Life & Health Insurer of the Year for 2021 and an Imagine Canada Caring Company.

Our 2,400 professionals work across six provinces, united by our shared values of being caring, accountable, responsible, innovative and community-minded. We’re committed to ensuring our employees thrive in our award-winning, collaborative culture focused on ensuring health, wellness, and personal and professional growth through a variety of programs and support across our organization.

Together with Medavie Health Services, we are part of Medavie — a national health solutions partner with over 7,700 employees. Our mission is to improve the wellbeing of Canadians.

Job Title: Medical Consultant (Medicare Programs-Monitoring)

Department: Medicare Programs

Competition: 87139

Internal/External: Internal/ External

Employment Type: External Consultant - Part-Time Hours

Location: Dartmouth, NS Office -Hybrid work available must be able to work in-office when required

Salary: Competitive Compensation

Reports To: Manager, Nova Scotia Provincial Programs

Role Summary:

We are currently accepting applications for an external Medical Consultant to join the Medicare Programs Team on a part time basis. The successful candidate will work with the Medicare Programs Team and will be responsible for supporting the MSI post- payment monitoring function. The Medical Consultant will provide the medical link between paying agency and providers. In collaboration with the MSI Audit Team, they will advise key stakeholders of Medavie Blue Cross and the Department of Health and Wellness of Nova Scotia on MSI Monitoring related matters including the development of policies and procedures.

As an MSI Monitoring Medical Consultant, your key responsibilities will include:

• Support a team of Medicare Auditors whose primary focus is to conduct billing audits.

• Support the evaluation of select alternative funding contracts, includes interviews with providers and other parties.

• Assist in the development of the annual audit plan, procedures to enhance monitoring operations.

• Participate and provide feedback into the development of risk analysis strategies to utilize departmental resources efficiently.

• Communicate with providers, Nova Scotia residents, Department of Health and Wellness, Doctors Nova Scotia, law enforcement, other government agencies in relation to MSI audit.

• Provide feedback and billing guidance to the audit team and physicians as required, in relation to billing audit results. This feedback can include face to face meetings to discuss audit findings.

• Support the development of Physician Education on the NS fee code and guidelines. Provide education to physician as requested through presentations and feedback through post payment audit results.

• Participate in various meetings with the Department of Health and Wellness and other stakeholders as required.

• Resolve issues and maintain productive, professional relationships with medical provider community and Department of Health and Wellness; inform providers through MSI Physician Bulletin publications of changing audit policies, administrative procedures, and billing issues.

• Liaise with and provide support to staff from other MSI departments including the provision of claims assessment support as required.

• Provide support to the Nova Scotia Department of Health and Wellness regarding physician appeals of billing audits. This support includes attending Facilitated Resolutions and Arbitrations to discuss audit findings.

• Maintain confidentiality, respecting both patients and provider matters.

As the ideal candidate, you possess the following qualifications:

Education: University degree with a Doctor of Medicine with an active medical license in good standing in the current jurisdiction, an active member with the Canadian Medical Protective Association and eligibility for licensure with the College of Physicians and Surgeons of Nova Scotia.

Work Experience: 10 to 15 years’ experience as a physician in a range of practice settings. Specialist training and administrative experience would be an asset.

Computer Skills: General computer knowledge, including functional knowledge of Microsoft Office products (Word, Excel, Power Point) and email.

Communication Skills: Excellent written and verbal communication skills are fundamental to the position. Strong interpersonal skills and the ability to build relationships, mentor and support providers and resolve conflicts.

Other Qualifications: Ability to travel throughout the province of Nova Scotia.

You also demonstrate the following core competencies:

Knowledge: Uses knowledge and industry best practices to provide guidance and/or advice to practitioners, leaders, and coworkers on key issues in own area of expertise. Demonstrates a specialized knowledge of all processes, policies, and precedents to do the job and solve day to day issues independently. This includes familiarity with safe prescribing guidelines, as well as relevant standards and expectations as outlined by each licensing authority.

Analytical Thinking: Uses knowledge and experience to solve a variety of routine and complex technical problems. Identifies the cause of problems and implements the most appropriate solution.

Communication: Able to communicate complex information effectively through both oral and written means. Demonstrates the full range of effective verbal communication skills in a variety of settings such as formal meetings, presentations and across disciplines.

Customer Orientation: Able to support, mentor and guide practitioners even when their viewpoint may be different than your own.

Execution and Organizational Skills: Exceptional organizational and time-management skills. Able to prioritize work within a changing work environment under the pressure of deadlines.

Teamwork: Provides professional advice and support to team members, proactively searches for ways to improve work effectiveness and performance.

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We are an Equal Opportunity Employer.

Medavie Blue Cross strives to foster a culture where everyone is enabled to achieve their full potential — a culture of diversity, equity and inclusion (DEI) where we live our values every day in the way we treat each other, our members and the communities we serve. Accessibility is a top priority.

For applicants with disabilities, we provide accommodations throughout the recruitment, selection and/or assessment process. If selected to participate in the recruitment, selection and/or assessment process, please inform Medavie Blue Cross Human Resources staff of the nature of any accommodation(s) that you may require in respect of any materials or processes used to ensure your equal participation. All personal information is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act.

We would like to thank all candidates for expressing interest. Please note only those selected for interviews will be contacted.

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