Remote Microsoft Contractor Jobs in Tennessee (NOW HIRING)

Summary Medical Affairs Coordinator – responsible for serving as the primary point of contact for all activities related to the Administrative Law Judge (ALJ) program, including medical record review, policy analysis, preparation for hearings, writing position papers, and testifying on behalf of CGS and the Medicare Program. Position Purpose Acts as the main liaison for the ALJ program, supporting ALJ team members in hearing preparation, policy interpretation, and court submissions. Location & Hours Full-time (40 hours/week), Monday to Friday, 8:00 AM–5:00 PM CST. Hybrid or remote. Office located at One Century Plaza, Nashville, TN. Security Clearance Must have the ability to obtain a security clearance and be a U.S. Citizen. Work Hours & Conditions Typical office environment with some travel required. Responsibilities Provide clinical expertise, research, and judgment to develop Local Coverage Determinations (LCDs) under the direction of the medical director. Maintain LCDs once developed. Educate providers and internal customers on LCDs. Communicate with interdepartmental staff regarding coding and reimbursement guidelines to ensure coordination and compliance. Provide clinical input for internal requests. Review inter‐rater reliability to ensure quality and consistency. Required Education and Qualifications Required Education: Bachelor's degree in a related field. Required Work Experience: 5 years of clinical experience in medical insurance, managed care, case management, or claims management, or a combination of these areas. Required Skills and Abilities: Knowledge of managed care or medical claims payment policy issues; working knowledge of word processing and spreadsheet software; excellent verbal and written communication, customer service, organizational, presentation, analytical and critical thinking skills; ability to persuade, negotiate, or influence others; ability to handle confidential or sensitive information with discretion; sound clinical review judgment; independent thinking and strong organization. Required Software: Microsoft Office. Required Licenses/Credentials: Active, unrestricted RN license in the United States and the state of hire, or an active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC). Preferred Education and Qualifications Preferred Education: Bachelor's degree in Nursing. Preferred Work Experience: 7 years of clinical experience in medical insurance, managed care, case management, or claims management, or a combination of these areas. Preferred Skills and Abilities: Working knowledge of database software; knowledge of government/healthcare programs, contracting laws, regulations, coding, and approval practices; knowledge of corporate administrative/medical policy across all lines of business; knowledge of benefits and coverage for all lines of business. Preferred Software: Working knowledge of Microsoft Access or other database software, DB2, and Easytrieve. Preferred Licenses/Credentials: HIAA, CCM, MPH, MHA certifications; Certified Genetic Counselor considered in lieu of RN license for Division 33. Benefits Employees are eligible to participate in benefits after 28 days of employment. Key benefits include Subsidized health, dental, and vision coverage 401(k) retirement savings plan with company match Life insurance Paid time off (PTO) On‐site cafeterias and fitness centers at major locations Education assistance and continuing education funds Employee discounts at movies, theaters, zoos, theme parks, and more Salary Range Minimum: $55,251.00 – Midpoint: $80,371.50 – Maximum: $105,492.00 Pay Transparency Statement Salary range represents the pay range for this position and related positions in this pay grade. Compensation decisions within the range depend on experience, geographic location, and internal equity. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. As a federal contractor, the company maintains affirmative action programs to promote opportunities for individuals with disabilities and protected veterans. We comply with applicable federal, state, and local laws and regulations and provide reasonable accommodations to individuals with disabilities, pregnant individuals, and individuals needing accommodations for sincerely held religious beliefs. Accommodation Assistance If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800‐288‐2227, ext.47480 with the nature of your request. We will determine reasonable accommodation on a case‐by‐case basis. Employment Verification We participate in E‐Verify. #J-18808-Ljbffr