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)
Policy Specialist
Under general supervision within the Office of Policy Development and Management (Policy Office), the Policy Specialist performs University policy, procedure, and standards research and analysis.
Formulates and edits institutional policies of University-wide significance and translates data into accessible material for a range of audiences. Collaborates with various internal committees to facilitate multiple projects and policies. Conducts topic-focused research and analysis and monitors data quality. Tracks full scope of projects and prepares progress reports.
Two years of experience requiring understanding of policy development and its analyses is a must, 2-3 years preferred or progress toward Law degree or Master of Public Policy is preferred. Strong written communication and PC skills necessary.
Duties are primarily sedentary. Must be able to use a computer at a desk or similar workstation, and travel to on-campus meetings as needed.
The University of Pittsburgh is committed to championing all aspects of diversity, equity, inclusion, and accessibility within our community. This commitment is a fundamental value of the University and is crucial in helping us advance our mission, which includes attracting and retaining diverse workforces. We will continue to create and maintain an environment that allows individuals to discover, belong, contribute, and grow, while honoring the experiences, perspectives, and unique identities of all.
The University of Pittsburgh is an Affirmative Action/Equal Opportunity Employer and values equality of opportunity, human dignity and diversity. EOE, including disability/vets.