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)
Native Preference in hiring is given to qualified enrolled members of Paskenta Band of Nomlaki Indians and Native Americans in accordance with the Band’s Preference Policy, Chapter 1-715 of the Paskenta Band of Nomlaki Indians Tribal Policies). Applicants claiming Indian Preference must submit verification of Indian certified by tribe of affiliation or other acceptable documentation of Indian heritage.
POSITION SUMMARY
Perform a wide variety of complex administrative duties under the direct supervision of the Policy Administrative Manager. The ideal candidate uses discretion and independent judgment to organize work effectively to meet critical administrative deadlines; completes projects and special assignments by establishing objectives, determining priorities, managing time, monitoring progress, problem solving and adjusting plans and priorities as needed. Must be comfortable managing multiple priorities, assigning priorities, setting up and documenting processes, finding efficiencies, and managing communications to implement processes and very effective time management and communication skills for the organization.
DUTIES & RESPONSIBILITIES
KNOWLEDGE, SKILLS & ABILITIES
MINIMUM QUALIFICATIONS
BACKGROUND CHECK REQUIREMENTS
Pre-employment Drug Testing and a Department of Justice Fingerprinting clearance through Federal, State and Child Abuse Index is a contingency for an offer of employment.
WORK ENVIRONMENT
The position requires prolonged sitting, standing, walking, reaching, twisting, turning, kneeling, bending, squatting, and stooping in the performance of daily activities. The position also requires grasping, repetitive hand movement and fine coordination in preparing reports using a computer keyboard. Additionally, the position requires near and far vision in proofreading correspondence and work-related documents. Acute hearing is required. Typically, office work setting conditions.
Employment with Paskenta Band of Nomlaki Indians is voluntarily entered. All PBNI personnel are employed on an at-will basis. At-will employment may be terminated with or without cause, and with or without notice at any time by the employee or by PBNI. No manager, supervisor, or employee of the organization has any authority to enter into an agreement for employment for any specified period or to make an agreement for employment other than at-will terms. The job description does not constitute an employment agreement between Paskenta Band of Nomlaki Indians and employee and is subject to change by the Paskenta Band of Nomlaki Indians.
0 Medical Policy Specialist jobs found in Chico, CA area