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)
Description: Under the direction of the MSO Director and Medical Staff Coordinator the Medical Staff Specialist is accountable for the credentialing and re-credentialing of all physicians and allied health practitioners. Also assist in maintaining numerous physician information data banks, including education, training, experience, certification, and licensure. Understands and follows the organization's policies, procedures, and standards. Is an independent worker, meeting the day-to-day needs. Participates in the department's performance improvement activities. This is a hybrid position post training period and will include the ability to work flexible hours and possess the ability to accept change.
Qualifications:
Proficient with Microsoft Office products – Word, Excel, Outlook, Power Point, Teams, and multiple databases. CAQH and MD Staff credentialing software is a positive.
Benefits:
Since 1941, Kirby Medical Center has been the premier provider of healthcare in Piatt County and surrounding areas. We are committed and proud to provide quality and compassionate healthcare services to people in need. Our values-based culture, employee engagement, and award winning healthcare have driven the success of our organization. Kirby Medical Center is an independent, not-for-profit hospital located on a beautiful campus in Monticello, IL with satellite clinics in Atwood, & Cerro Gordo, IL. Kirby Medical Center offers an outstanding benefits package and state-of-the-art medical equipment. Ideal candidates enjoy a workplace where compassion, positive attitudes, respect, excellence, and stewardship are on display every day.
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0 Medical Policy Specialist jobs found in Champaign, IL area