Medical Policy Specialist jobs in Battle Creek, MI

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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Operations Specialist Medical Group Hospital Services
  • Corewell Health
  • Southfield, MI FULL_TIME
  • Job Summary

    The Operations Specialist will work in partnership with leadership and various operational teams and organizational departments to develop, implement and support programs and projects that ensure operational efficiency, enhanced safety, increased productivity, reduced cost, and continuous improvement. Managing the day-to-day operational needs of various hospital based service lines: Emergency Medicine, Hospital Medicine, Palliative Care, Radiology, Radiation Oncology, and Pulmonary Medicine.

    Essential Functions

    • Provides operational support for new and existing programs and projects. Ensures required documentation, reporting, data collection and database utilization are performed in an accurate and timely manner. Prepares progress reports, study results and other reports as required.
    • Collects and analyzes process, productivity, value and quality related data to initiate, develop, and recommend operational practices and procedures that focus on operational efficiency, enhanced safety, increased productivity, and reduced cost.
    • Engages in process and quality improvement initiatives. Responsible for implementing recommendations to improve operational efficiency, new services for area of responsibility and creates documentation of new established workflows.
    • Serves as the operational lead to provide structure, project management and direction for new and existing workflow transformation and other operational initiatives. Collaborates with leadership to develop action and projects plans focused on operations and running the business.
    • Assists with the coordination of compliance activities to ensure services are provided in accordance with State and Federal regulations, organizational policies and procedures, medical staff bylaws and accreditation/compliance requirements.

    Qualifications

    • Required Bachelor's Degree or equivalent business, healthcare administration or related field
    • 3 years of relevant experience required
    • Experience in healthcare and working within in an organization of size and complexity comparable to Corewell Health Preferred
    • Proficient with Microsoft Office Suite
    • Experience interfacing with physicians
    • Analytical and business acumen

      Physical Demands

      • Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 10 lbs
      • Waist to Waist > 5 lbs: Seldom up to 10 lbs
      • Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs
      • Waist to Overhead > 5 lbs: Seldom up to 10 lbs
      • Bilateral Carry > 5 lbs: Seldom up to 10 lbs
      • Unilateral Carry > 5 lbs: Seldom up to 10 lbs
      • Pushing Force > 5 lbs: Seldom up to 10 lbs
      • Pulling Force > 5 lbs: Seldom up to 10 lbs
      • Sitting: Frequently
      • Standing: Occasionally
      • Walking: Occasionally
      • Forward Bend - Standing: Seldom
      • Forward Bend - Sitting: Occasionally
      • Trunk Rotation - Standing: Seldom
      • Trunk Rotation - Sitting: Occasionally
      • Reach - Above Shoulder: Seldom
      • Reach - at Shoulder or Below: Seldom
      • Handling: Occasionally
      • Forceful Grip > 5 lbs: Seldom
      • Forceful Pinch > 2 lbs: Seldom
      • Finger/Hand Dexterity: Frequently

      Primary Location

      SITE - Beaumont Service Center - 26901 Beaumont Blvd

      Department Name

      Corp Med Administration Non Physician - CHMG East

      Employment Type

      Full time

      Shift

      Day (United States of America)

      Weekly Scheduled Hours

      40

      Hours of Work

      8 a.m. to 4:30 p.m.

      Days Worked

      Monday to Friday

      Weekend Frequency

      N/A

      CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.

      Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

      Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

      An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

      You may request assistance in completing the application process by calling 616.486.7447.

    • 2 Days Ago

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    Medical Transport Specialist / Driver Part-Time (Weekend)
    • Quest Diagnostics
    • Kalamazoo, MI PART_TIME
    • Overview Medical Transport Specialist / Driver Part-Time (Weekend) - Kalamazoo, MI Saturday & Sunday 3:00pm-11:00pm **Route goes all over SW Michigan, Kalamazoo, Benton Harbor, Niles, coldwater, Battl...
    • 12 Days Ago

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    Rn - medical nursing nights
    • Firstat Medical Staffing
    • Osseo, MI FULL_TIME
    • Firstat Medical Staffing is seeking a travel nurseRN Med Surg / Telemetry for a travel nursing job in Osseo, Wisconsin.Job Description & Requirements~ Specialty: Med Surg / Telemetry~ Discipline:RN~ S...
    • 27 Days Ago

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    Travel Registered Nurse RN Medical Surgical
    • OneStaff Medical
    • BATTLE CREEK, MI FULL_TIME
    • We. Are. OneStaff. Medical. An independently - owned, nationally - recognized and amazingly awesome staffing firm ready to work for you! A work ethic forged in the Midwest, we are here to stand by you...
    • 1 Month Ago

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    Medical Courier Job
    • Medical Courier Job Jobs Hiring
    • Athens, MI FULL_TIME
    • (Hiring Immediately) Part/Full-Time Medical Courier Job Jobs Available in Athens, MI. No Experience Required.
    • 23 Days Ago

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    Medical Courier Jobs
    • Medical Courier Jobs Jobs Hiring
    • Athens, MI FULL_TIME
    • (Hiring Immediately) Part/Full-Time Medical Courier Jobs Jobs Available in Athens, MI. No Experience Required.
    • 23 Days Ago

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    0 Medical Policy Specialist jobs found in Battle Creek, MI area

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    LPN Charge Nurse
    • Calhoun County Medical Care Facility
    • Battle Creek, MI
    • Join our TEAM! Calhoun County Medical Care Facility is seeking LPN Charge Nurses to join our team! Are you looking for a...
    • 4/24/2024 12:00:00 AM

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    Truck Care Tire Technician
    • Hiring Now!
    • Battle Creek, MI
    • Req ID:428990 Address: 18720 Partello Rd. Marshall, MI, 49068 Benefits:* Paid Time Off * Flexible Scheduling * 401(k) 10...
    • 4/23/2024 12:00:00 AM

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    Travel Registered Nurse RN Long Term Acute Care LTAC
    • OneStaffMedical
    • BATTLE CREEK, MI
    • We. Are. OneStaff. Medical. An independently - owned, nationally - recognized and amazingly awesome staffing firm ready ...
    • 4/23/2024 12:00:00 AM

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    Romantix Retail Part Time Sales Associate BC
    • Romantix
    • Battle Creek, MI
    • Job Title Sales Associate Compensation $12.00 per hour + bonus & incentives On-Demand Pay. Gain early access to your mon...
    • 4/22/2024 12:00:00 AM

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    Part-Time Stocker
    • Aldi, Inc.
    • Battle Creek, MI
    • We're ALDI, one of America's favorite grocers. We've grown a lot in the past few years, expanding our reach and customer...
    • 4/22/2024 12:00:00 AM

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    Commercial Sales Manager
    • AutoZone, Inc.
    • Battle Creek, MI
    • The Commercial Sales Manager is responsible for driving the commercial sales within their AutoZone location. The CSM dev...
    • 4/21/2024 12:00:00 AM

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    FT Data Entry Specialist - Work From Home>
    • Sharecare
    • Battle Creek, MI
    • [Administrative Assistant / Remote] - Anywhere in U.S. / Competitive pay - As a Data Entry Specialist you'll: Access var...
    • 4/20/2024 12:00:00 AM

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    Biomedical Equipment Support Specialist (Imaging)
    • U.S. Food and Drug Administration
    • Battle Creek, MI
    • ** Biomedical Equipment Support Specialist (Imaging)** **Department of Veterans Affairs** **Summary** This position is e...
    • 4/20/2024 12:00:00 AM

    Battle Creek is a city in the U.S. state of Michigan, in northwest Calhoun County, at the confluence of the Kalamazoo and Battle Creek rivers. It is the principal city of the Battle Creek, Michigan Metropolitan Statistical Area (MSA), which encompasses all of Calhoun County. As of the 2010 census, the city had a total population of 52,347, while the MSA's population was 136,146. According to the United States Census Bureau, the city has a total area of 43.73 square miles (113.26 km2), of which 42.61 square miles (110.36 km2) is land and 1.12 square miles (2.90 km2) is water, making Battle Cree...
    Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
    Income Estimation for Medical Policy Specialist jobs
    $88,282 to $107,763
    Battle Creek, Michigan area prices
    were up 1.3% from a year ago

    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