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)
OVERALL RESPONSIBILITIES:
The ICS is responsible for monitoring and follow-up of durable medical equipment claims, orders, and invoices. Additionally, the ICS is responsible for coordinating the timely and accurate follow-up of rejected, denied, underpaid, and delinquent insurance claims. The ICS works to resolve claims issues with the processing teams and management to maximize collections in an ethical and compliant manner as set forth in the company compliance plan.
SPECIFIC DUTIES:
OVERALL RESPONSIBILITIES:
The ICS is responsible for monitoring and follow-up of durable medical equipment claims, orders, and invoices. Additionally, the ICS is responsible for coordinating the timely and accurate follow-up of rejected, denied, underpaid, and delinquent insurance claims. The ICS works to resolve claims issues with the processing teams and management to maximize collections in an ethical and compliant manner as set forth in the company compliance plan.
SPECIFIC DUTIES:
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