Medical Policy Specialist jobs in Idaho

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)

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Medical Policy Implementation Analyst Sr
  • Cambia Health
  • Pocatello, ID FULL_TIME
  • Medical Policy Implementation Analyst SrRemote in ID, OR, WA, UTPrimary Job PurposeThe Medical Policy Implementation Analyst Sr identifies, recommends, and publishes clinical policy criteria for all lines of business.

    Organizes and maintains policies so they are accessible to internal and external customers. Consults with Medical Directors and other internal staff on policy development and implementation as well as system application.

    General Functions and Outcomes* Effectively drafts, interprets, and applies medical policies and assists in the workload distribution of the medical policy team.

    Present policy criteria recommendations to Medical Directors and other internal staff for approval.* Appropriately applies procedural and diagnostic coding (CPT, HCPCS, and ICD) to policy criteria with an understanding of the impact on policy implementation.

    • Implements, maintains, and publishes on the web a library of clinical criteria that is accessible to internal and external customers.
    • Works with system users and databases to ensure consistent application and implementation of policies.* Develops and maintains related department procedures.
    • Ability to manage project tasks, set objectives, goals, and develop schedules while meeting deadlines and documentation requirements for accreditation standards with minimal supervision.
    • Interprets the policy criteria for entry into CWQI Guideline Modification Module for clinical review.* Advise and communicate with internal and external stakeholders regarding policy questions, decisions, outcomes.

    Minimum Requirements* In-depth knowledge of anatomy and physiology, disease processes, medical and CMS policies, MCG criteria, clinical utilization management, case management or behavioral health management.

    • Competency interpreting and applying CPT, ICD, and HCPCS coding for medical technologies, procedures, and services.* Familiarity with utilization review and clinical claim review process.
    • Demonstrated analytical ability to identify problems, develop solutions, and implement a chosen course of action with internal and external medical professionals and other experts.
    • Strong organization skills, independent worker, and proficiency in Microsoft Office and various Web-based internet applications.
    • Ability to communicate effectively, verbally and in writing.* Ability to appraise, summarize, and present research and clinical practice guideline recommendations to inform policy criteria.
    • Demonstrated success with project management and ability to serve as key member of project team.Normally to be proficient in the competencies listed aboveMedical Policy Implementation Analyst Sr would have a Bachelor's degree in health science or related field (e.

    g., nursing, public health) and 5 years of experience in working with medical policies and 3 years of direct clinical experience or equivalent combination of education and experience.

    Required Licenses, Certifications, Registration, Etc.* Certified Professional Coder (CPC) preferred. If no CPC currently, employee must attain CPC within 6 months of hire.

    Register Nurse (RN) license (must have a current unrestricted RN license)#LI-RemoteThe expected hiring range for a Medical Policy Implementation Analyst Sr is $82,500 - $111,600 depending on skills, experience, education, and training;

    relevant licensure / certifications; performance history; and work location. The bonus target for this position is 10% .

    The current full salary range for this role is $77,000 - $127,000.Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits.

    In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current.

    Some highlights : * medical, dental, and vision coverage for employees and their eligible family members* annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)* paid time off varying by role and tenure in addition to 10 company holidays* up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)* up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)* one-time furniture and equipment allowance for employees working from home* up to $225 in Amazon gift cards for participating in various well-being activities.

    for a complete list see our External Total Rewards page.We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace.

    All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law.

    A background check is required.If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.

    com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.

    As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.

    8 hours ago
  • 4 Days Ago

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DMV Program Specialist - Policy and Stakeholder Engagement team
  • State of Idaho
  • Boise, ID FULL_TIME
  • Description NOTICE: Applications will be accepted through 4:59 PM MST on the posting end date. If you are a current or temporary State of Idaho employee you MUST apply through your internal Luma accou...
  • 11 Days Ago

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Virtual Medical Collections Specialist
  • West Valley Medical Center
  • Caldwell, ID FULL_TIME
  • Hourly Wage Estimate: $15.00 - $22.50 / hour Learn more about the benefits offered for this job. The estimate displayed represents the typical wage range of candidates hired. Factors that may be used ...
  • 3 Days Ago

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Cosmetic Merchandiser (2023-31313)
  • Apollo Retail Specialist
  • Boise, ID PART_TIME
  • As a cosmetic merchandiser, you’ll take on project-based work to ensure cosmetic products, graphics, and displays are visually appealing to attract and engage shoppers, build strong relationships with...
  • 21 Days Ago

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Telecommunications Tower Technician Green Hand
  • Larson Tower Specialist
  • Boise, ID FULL_TIME
  • Job Description Job Description Benefits : SIRA matching Bonus based on performance Company parties Competitive salary Dental insurance Employee discounts Health insurance Opportunity for advancement ...
  • 3 Days Ago

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Telecommunications Tower Technician Green Hand
  • Larson Tower Specialist
  • Idaho Falls, ID FULL_TIME
  • Job Description Job Description Benefits : SIRA matching Bonus based on performance Company parties Competitive salary Dental insurance Employee discounts Health insurance Opportunity for advancement ...
  • 3 Days Ago

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Ambulatory Medication Specialist
  • Children's National Medical Center
  • Washington, DC
  • Under the direct supervision of a registered pharmacist and under the leadership the Pharmacy Management staff, the Ambu...
  • 3/28/2024 12:00:00 AM

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Medical Specialist 2
  • New York State Civil Service
  • Thiells, NY
  • Agency People With Developmental Disabilities, Office for Title Medical Specialist 2 Occupational Category Health Care, ...
  • 3/28/2024 12:00:00 AM

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Medical Specialist - Pulmonology - Gary, IN
  • Regeneron Pharmaceuticals
  • Indianapolis, IN
  • The Medical Specialist (Sales Representative), Pulmonology (MS) will be responsible for engaging Pulmonologists and othe...
  • 3/28/2024 12:00:00 AM

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(Physician) Medical Specialist 2
  • Office for People with Developmental Disabilities
  • Thiells, NY
  • Job Description Job Description EMPLOYMENT OPPORTUNITY ANNOUNCEMENT EOA #: 23-061RR EOA DATE: March 15, 2024 REPLY BY: S...
  • 3/27/2024 12:00:00 AM

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Medical Assistant/ Medication Specialist
  • Nidraveda PA
  • San Antonio, TX
  • Job Description Job Description We are looking for someone with a professional attitude, a dedication to healthcare, and...
  • 3/27/2024 12:00:00 AM

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Medication Specialist
  • Behavorial Health Network, Inc
  • Boston, MA
  • Use your knowledge of addiction recovery and medication management with BHN! Join our team of competent and compassionat...
  • 3/26/2024 12:00:00 AM

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Medical Assistant, Medical Specialists
  • UP Health System - Marquette
  • Marquette, MI
  • UP Health System - Marquette Medical Assistant, Medical Specialists, 1.0DV Who We Are: People are our passion and purpos...
  • 3/26/2024 12:00:00 AM

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Medical Specialist 2
  • StateJobsNY
  • Queens Village, NY
  • MMINIMUM QUALIFICATIONS: Possession of a license to practice medicine in New York State (see limited permit option below...
  • 3/25/2024 12:00:00 AM

Idaho (/ˈaɪdəhoʊ/ (listen)) is a state in the northwestern region of the United States. It borders the state of Montana to the east and northeast, Wyoming to the east, Nevada and Utah to the south, and Washington and Oregon to the west. To the north, it shares a small portion of the Canadian border with the province of British Columbia. With a population of approximately 1.7 million and an area of 83,569 square miles (216,440 km2), Idaho is the 14th largest, the 12th least populous and the 7th least densely populated of the 50 U.S. states. The state's capital and largest city is Boise. Idaho p...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Policy Specialist jobs
$82,868 to $101,154

Medical Policy Specialist in Norfolk, VA
Guideline 9 – specialist medical procedures provides that applications for the separate representation of children with an intellectual impairment in relation to applications for special medical procedures are not subject to the means test or merits test.
February 20, 2020