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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Nature of Work: Under general supervision, this position will provide Family Assistance Policy and Systems Training to new and tenured staff. Interprets federal and state laws, regulations, and policies for staff to ensure that training property represents policy in the curriculum. Writes, edits, and develops curricula consistent with a competency-based training system to ensure basic proficiency and continued professional development of Family Assistance and clerical staff. Uses independent judgment in administrative and operational aspects of training provision including use of facilities, classroom management, equipment management, and trainee supervision. Acts as a liaison with regional and district offices to ensure that training needs are met. Other duties as assigned. This position requires statewide travel.
2 Vacancy
Statewide
Minimum Qualifications
Training: Bachelor's Degree from a regionally accredited four-year college or university. Substitution: Additional experience as described below may be substituted for the required training on a year-for-year basis.
Experience: Four years full-time, equivalent part-time paid or volunteer experience in a technical or program area that is related to the area of employment. Substitution: Post-graduate education in a field related to the technical or program area may be substituted for the required experience on the basis of fifteen semester hours for one year of experience.
Job Type: Full-time
Pay: $35,994.00 - $66,589.00 per year
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Work Location: In person