Manager, Medical Affairs

Medicare Medical Policy Leadership | Fully Remote

About the Opportunity

An established healthcare administrative services organization is seeking a Manager, Medical Affairs to lead a fully remote Medicare medical policy team.

This leader will oversee the development, implementation, and ongoing maintenance of coverage policies that guide coding, billing, claims processing, reimbursement, and provider education.

The strongest candidates will have experience working where clinical evidence and Medicare requirements are translated into written policy and operational rules. Direct Local Coverage Determination (LCD) or Medicare Administrative Contractor (MAC) experience is highly relevant. Comparable experience in payer medical policy, payment policy, coding policy, payment integrity, or Medicare operations may also align when it includes meaningful policy ownership and leadership responsibility.

Medical Review experience is relevant when it includes responsibility for policy, coding, claims, quality, or program ownership.

What You Will Lead

• Lead a multidisciplinary team that may include policy nurses, research analysts, pricing consultants, business analysts, medical research consultants, and other specialized personnel.
• Oversee clinical evidence research and the development, revision, maintenance, and communication of Medicare medical and coverage policies.
• Manage Local Coverage Determination activities, including proposed and final policies, reconsiderations, revisions, retirements, and related coverage and billing articles.
• Translate policy decisions into coding guidance, claims edits, reimbursement logic, contractor pricing, system requirements, operational workflows, and staff education.
• Partner with Contractor Medical Directors on complex clinical, coverage, coding, pricing, reimbursement, and policy questions.
• Oversee stakeholder engagement, including provider and physician communication, Contractor Advisory Committee activities, and CMS-required Open Meetings.
• Assign and track policy, pricing, coding, clinical, and medical-director inquiries while managing workload, deadlines, quality, training, and team performance.
• Lead quality controls, root cause analysis, corrective action, process improvement, departmental procedures, and timely CMS reporting.

Required Qualifications

• Registered Nurse professional background. Current RN license status will be verified during the selection process.
• Bachelor's degree.
• At least 5 years of related Medicare experience.
• At least 4 years of direct supervision, project leadership, program leadership, or comparable experience with accountability for people, deliverables, implementation, quality, or regulated operational outcomes.
• Experience developing, revising, owning, or operationalizing medical, coverage, payment, coding, claims-edit, reimbursement, or related Medicare policy.
• Strong understanding of how Medicare policy connects to medical necessity, coding, claims processing, reimbursement, pricing, and operational implementation.
• Ability to evaluate clinical and regulatory information, make sound decisions, and communicate effectively with physicians, medical directors, providers, CMS stakeholders, and operational teams.
• Strong planning, organization, problem-solving, written communication, and team-leadership skills.

Relevant Backgrounds

Relevant experience may come from:

• Medicare Fee-for-Service
• Medicare Advantage
• Medicare Administrative Contractors
• Other CMS contractors
• Payer medical policy
• Payment integrity
• Clinical policy and coding
• Reimbursement
• Audit-concept development

Comparable experience should demonstrate a clear connection among Medicare requirements, written policy or decision rules, claims or coding impact, and accountable leadership.

Preferred Qualifications

• Bachelor of Science in Nursing (BSN).
• Certified Professional Coder (CPC) credential.
• Direct Medicare Administrative Contractor, Local Coverage Determination, or CMS-contractor experience.
• Experience with MCS, FISS, Medicare claims edits, contractor pricing, coverage and billing articles, or related policy systems and outputs.
• Experience supporting Contractor Medical Directors.
• Experience leading or supporting Contractor Advisory Committee activities, CMS Open Meetings, provider education, or other external stakeholder activities.
• Experience leading quality controls, corrective action, regulated reporting, and process improvement through staff or cross-functional teams.

Compensation and Work Model

• Base Salary: $100,000 to $115,000 annually
• Bonus Opportunity: 10%
• Work Model: Fully remote within approved hiring locations
• Employment Status: Exempt
• Start Date: As soon as possible
• Location eligibility will be confirmed during the selection process.

How to Apply

Submit a current resume for consideration.

Candidates who have directly written, developed, revised, implemented, or operationalized Medicare medical, coverage, payment, coding, reimbursement, or claims policy are especially encouraged to apply.

Ascendo is a certified minority owned staffing firm, and we welcome and celebrate diversity. Ascendo is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, parental status, military service or any other characteristic protected by federal, state or local law.

Contact information

Christian Kincer