Medical Policy Specialist jobs in Pennsylvania

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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Policy Specialist
  • The University of Pittsburgh
  • Pittsburgh, PA FULL_TIME
  • Policy Specialist

    Policy Development and Management - Pennsylvania-Pittsburgh - (24002917)


    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.

    • Responsible for formulating and editing institutional policies of University-wide significance and application, and participates in policy development and revision, including working with members of committees across the University.
    • Collaborates with faculty and staff at all levels within the institution.
    • Integrates and manages University policy information in both electronic and published formats.
    • Provides coordination for multiple policy development and related projects, as assigned.

    The position is expected to provide input into the strategic direction and the development and use of polices at the University generally and the Policy Office specifically.

    Job Summary

    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.

    Essential Functions

    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.


    Physical Effort

    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.


    Assignment Category
    Full-time regular
    Job Classification
    Staff.Policy Analyst I
    Job Family
    Legal
    Job Sub-Family
    Policy
    Campus
    Pittsburgh
    Minimum Education Level Required
    Bachelor's Degree
    Minimum Years of Experience Required
    2
    Will this position accept substitution in lieu of education or experience?
    Combination of education and relevant experience will be considered in lieu of education and/ or experience requirement.
    Work Schedule
    Monday - Friday 8:30 a.m. - 5:00 p.m.
    Work Arrangement
    Hybrid: Combination of On-Campus and Remote work as determined by the department.
    Hiring Range
    TBD Based Upon Qualifications
    Relocation Offered
    No
    Visa Sponsorship Provided
    No
    Background Check
    For position finalists, employment with the University will require successful completion of a background check
    Child Protection Clearances
    Not Applicable
    Required Documents
    Resume
    Optional Documents
    Cover Letter
  • 12 Days Ago

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Specialist, Medical Office
  • TruGreen - Lawn Specialist - Mill Hall, PA
  • Clarence, PA FULL_TIME
  • Immediate Openings in Mill Hall, PA At TruGreen, we are committed to our customers, our teams, our values, and the science of lawn care. Start at $16 per hour Average income is $850 - $1,200 per week*...
  • 3 Days Ago

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Medical Policy Coordinator
  • Independence Blue Cross Careers
  • Philadelphia, PA FULL_TIME
  • Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. ...
  • 2 Months Ago

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Medical Policy & Coding Consultant I
  • Capital Blue Cross
  • Harrisburg, PA FULL_TIME
  • Position Description At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us...
  • Just Posted

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Medical Device Specialist
  • B. Braun Medical Inc.
  • Pittsburgh, PA FULL_TIME
  • Overview: About B. Braun B. Braun Medical Inc., a leader in infusion therapy and pain management, develops, manufactures, and markets innovative medical products and services to the healthcare industr...
  • Just Posted

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Manager Research Project B (Department of Medical Ethics & Health Policy)
  • University of Pennsylvania
  • Philadelphia, PA FULL_TIME
  • University Overview The University of Pennsylvania, the largest private employer in Philadelphia, is a world-renowned leader in education, research, and innovation. This historic, Ivy League school co...
  • 1 Day Ago

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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...
  • 4/25/2024 12:00:00 AM

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Medical Specialist
  • PSG Global Solutions Careers
  • South San Francisco, CA
  • Apply now and our proprietary system will quickly have you in front of a live recruiter. The Opportunity Description We'...
  • 4/24/2024 12:00:00 AM

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Medical Specialist 1
  • StateJobsNY
  • Tupper Lake, NY
  • Minimum Qualifications: Open Competitive: Possession of a license and current registration to practice medicine in New Y...
  • 4/23/2024 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...
  • 4/22/2024 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...
  • 4/22/2024 12:00:00 AM

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RN-WMG-Endo Medical Specialist-Days
  • Wellstar Medical Specialists
  • Marietta, GA
  • Summary: Ambulatory/Outpatient refers to medical services performed on an outpatient basis, without admission to a hospi...
  • 4/22/2024 12:00:00 AM

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Medical Specialist
  • U.S. Air Force Reserve
  • Position Summary Our hundreds of medical facilities around the world are only as good as the staff who run them. Providi...
  • 4/21/2024 12:00:00 AM

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Inventory Medical Specialist - Materials Services OR
  • Hoag Memorial Hospital Presbyterian
  • ** Inventory Medical Specialist - Materials Services OR** Department: Support Services Status: Full Time Shift: 1st **Pr...
  • 4/21/2024 12:00:00 AM

Pennsylvania (/ˌpɛnsɪlˈveɪniə/ (listen) PEN-sil-VAY-nee-ə), officially the Commonwealth of Pennsylvania, is a state located in the northeastern and Mid-Atlantic regions of the United States. The Appalachian Mountains run through its middle. The Commonwealth is bordered by Delaware to the southeast, Maryland to the south, West Virginia to the southwest, Ohio to the west, Lake Erie and the Canadian province of Ontario to the northwest, New York to the north, and New Jersey to the east. Pennsylvania is the 33rd-largest state by area, and the 6th-most populous state according to the most recent of...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Policy Specialist jobs
$89,266 to $108,964

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