Medical Policy Specialist researches and designs criteria to determine policy guidelines used in review of patient cases to ensure only medically appropriate services are reimbursed. Recommends a policy and process that ensure alignment with company guidelines and nationally accepted medical/coding standards. Being a Medical Policy Specialist establishes the proper codes to use for claims processing. Responds to questions from medical staff and communicates details about policy and guidelines. Additionally, Medical Policy Specialist requires a bachelor's degree. Typically reports to a supervisor or manager. Requires Registered Nurse RN. The Medical Policy Specialist gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Medical Policy Specialist typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
The Policy Quality Control Specialist works collaboratively with team members, as well as independently, to accomplish their daily tasks and duties, with the ultimate goal of providing excellent customer service. This individual will review and ensure accuracy on client life and/or annuity policies, as well as, work with the New Business department to complete the necessary corrections. The Policy Quality Control Specialist is expected to communicate effectively, resolve issues as they arise and prioritize workflows and tasks to accomplish daily duties.
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EquiTrust is an Equal Opportunity Employer and participates in the U.S. Federal E-Verify program. Applicants have rights under federal and state employment laws. To learn more, visit https://www.equitrust.com/careers/opportunities/federal-and-state-employment-laws/.