Medical Consultant (Medicare Programs-Monitoring)

Medavie Blue Cross; Nova Scotia; On-site; CAD 80,000 - 100,000; Part time

Job summary

A healthcare provider in Nova Scotia is seeking a part-time Medical Consultant to support Medicare programs. The successful candidate will work with the Medicare Programs Team and advise on policies and procedures related to MSI monitoring. Responsibilities include conducting billing audits, collaborating with stakeholders, and providing education to healthcare providers. A Doctor of Medicine degree and extensive experience are required.

Qualifications

• 10 to 15 years’ experience as a physician is required.
• Specialist training and administrative experience would be an asset.
• Ability to travel throughout the province of Nova Scotia.

Responsibilities

• Support a team of Medicare Auditors conducting billing audits.
• Develop annual audit plan and procedures.
• Communicate with various stakeholders regarding MSI audit.

Skills

Analytical Thinking

Communication Skills

Customer Orientation

Execution and Organizational Skills

Teamwork

Education

Doctor of Medicine degree with active medical license

Tools

Microsoft Office Suite (Word, Excel, PowerPoint)

Job description

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.

Responsibilities

• 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.

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.