Medical Policy Manager manages and implements corporate policy and process for medical provider and other reimbursements. Ensures that all claims are reviewed, settled, and processed in compliance with and according to contract provisions and regulatory requirements. Being a Medical Policy Manager evaluates and develops policies and provider reimbursement guidelines to effectively manage and control medical claims cost. Requires a bachelor's degree of finance, business or healthcare administration. Additionally, Medical Policy Manager typically reports to head of a unit/department. The Medical Policy Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Medical Policy Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)
Responsible for providing leadership and broad strategic direction in the area of Senior Services particularly PPO and HMO Medicare and Medicare Advantage lines of business. Responsible for corporate policy interpretation, recommendation and review within recognized area of responsibility.
"Qualifications"
Departmental Preferences / Summary:
Five (5) years of experience and in utilization review with strong understanding of CMS regulations not limited to NCD and LCD, Medicare product cycle and benefit design requirements.
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