Medical Policy Specialist jobs in Cleveland, OH

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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Policy Admin Specialist
  • Roundstone
  • Lakewood, OH FULL_TIME
  • Policy Administration Specialist
    Founded in 2003, Roundstone is not your typical insurance company. We’re on a mission to help employers save on healthcare benefits so they can put those savings towards bettering their businesses and taking care of their employees.
    Role Description
    As a Policy Administration Specialist you will be responsible for creating stop loss proposals and, once the account is bound, for executing and managing the contracting process. This role requires exceptional attention to detail and a service-oriented attitude to provide best-in-class service to all of our customers. Your goal throughout the binding process is to ensure a positive, smooth and hassle-free contracting experience for our clients.
    Key Duties & Responsibilities:
    • Proposal and contract generation
    • Broker/Advisor communication
    • Data analytics
    • Salesforce utilization
    • Policy administration
    • Underwriting support
    • Process optimization
    • TPA administration
    Skills and Qualifications:
    We’re looking for someone eager to learn the specifics of the Policy Administration department’s functions and use their knowledge to be driven, inquisitive and further both the team’s and Roundstone’s growth. You will receive extensive hands-on training from teammates with the goal of career advancement based on interest and aptitude. Other responsibilities and learning opportunities in other departments may be required on occasion as business levels warrant.
    Desired Qualifications:
    • Bachelor’s degree or equivalent experience
    • Ability to prioritize projects and deliverables, while maintaining flexibility to accommodate time sensitive requests
    • Proficiency in Microsoft Office (Excel, Word, PowerPoint)
    • Knowledge of Salesforce.com or similar CRM database applications along with the ability to learn new software systems
    • Ability to work with a high degree of independence, creativity and entrepreneurial spirit in a fast-paced, rapidly growing business
    • Detail-oriented proficiency with a strong commitment to accuracy
    Better Benefits:
    We’re leaders in our industry, so naturally, we look out for our employees’ best interests with a robust benefits package. Roundstone employees are eligible for:
    • Medical, dental and vision benefits
    • Annual bonus
    • Dependent care 100% match up to max allowable
    • PTO beginning on Day 1
    • Tuition reimbursement
    • Health work/life balance
    • Hybrid office schedule
    • 401(k) plan with company match
    • Employee Assistance Program
    • On-site gym with personal trainer access
    • Life insurance and short term disability insurance
    More About Roundstone
    Headquartered in Lakewood, Ohio, Roundstone is regularly recognized as a Northeast Ohio Top Workplace by the Plain Dealer and cleveland.com. We are especially proud to be recognized as a Top Workplace since this honor is determined by anonymous feedback from our own employees. Roundstone employees enjoy a supportive workplace where they are engaged, valued and regularly recognized for their hard work at monthly company meetings. Roundstone’s core values are evident every day and are shared with the community through the sponsorship of community events and outreach.
    Our Core Values
    • Live well: Be healthier and bring positive energy to all you do.
    • Work smarter: Get things done, better.
    • Own it: Accountability is your middle name. Be on time, do what you say, and finish what you start.
    • Be intellectually curious: Always be learning. See opportunity everywhere and have a drive to know.
    Culture and fit are integral to success and in an effort to achieve a better match both from a candidate's perspective and our organization, please take a minute, click on the link and take the really brief survey:
    https://go.cultureindex.com/p/0Dnvf9IQrCuWvBoq
    Don't meet every single requirement? Studies have shown that women and people of color are less likely to apply to jobs unless they meet every single qualification. At Roundstone Insurance we are dedicated to building a diverse, inclusive, and authentic workplace, so if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyways. You may be just the right candidate for this or other roles.
  • 1 Month Ago

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Coordinator - Drug Policy - Pharmacy Admin
  • METROHEALTH MEDICAL CENTER
  • Cleveland, OH FULL_TIME
  • Location: METROHEALTH MEDICAL CENTER Biweekly Hours: 80.00 Shift: 8:00-4:30 The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community h...
  • 3 Days Ago

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Physician-Health Care Research & Policy
  • METROHEALTH MEDICAL CENTER
  • Cleveland, OH FULL_TIME
  • Location: METROHEALTH MEDICAL CENTER Biweekly Hours: 80.00 Shift: 8-4 The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health ...
  • 18 Days Ago

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Durable Medical Equipment Specialist, CSR
  • Medical Service Company
  • Cleveland, OH FULL_TIME
  • MEDICAL SERVICE COMPANY is a family owned and operated durable medical equipment and respiratory provider that's been in business for 70 years! MSC is a 12-Time recipient of the prestigious NorthCoast...
  • 12 Days Ago

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Practice Support Specialist-Medical Specialties Admin
  • METROHEALTH MEDICAL CENTER
  • Cleveland, OH FULL_TIME
  • Location: METROHEALTH MEDICAL CENTER Biweekly Hours: 80.00 Shift: 8-5 pm Mon-Fri The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of commun...
  • 21 Days Ago

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Simulation Training Specialist -Medical Simulation Training PRN
  • METROHEALTH MEDICAL CENTER
  • Cleveland, OH FULL_TIME
  • Location: METROHEALTH MEDICAL CENTER Biweekly Hours: 16.00 Shift: 7:00-5:00 The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community h...
  • 1 Day Ago

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0 Medical Policy Specialist jobs found in Cleveland, OH area

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Intervention Specialist at Pinnacle Academy
  • National Heritage Academies
  • Cleveland, OH
  • This '23-'24 School year role is eligible for a recruitment bonus up to $8,000 SCHOOL INFORMATION: Located in Euclid, OH...
  • 3/29/2024 12:00:00 AM

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Business Analyst Sr. - Corporate & Institutional Banking
  • PNC Financial Services Group, Inc.
  • Cleveland, OH
  • Position Overview At PNC, our people are our greatest differentiator and competitive advantage in the markets we serve. ...
  • 3/29/2024 12:00:00 AM

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Early Childhood Behavioral Specialist-Cleveland, OH
  • OhioGuidestone
  • Cleveland, OH
  • Where New Paths Begin OhioGuidestone is the state's leader in community behavioral health care, serving around 26,000 Oh...
  • 3/29/2024 12:00:00 AM

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Pharmacy Technician PT
  • Ingles Markets, Incorporated
  • Cleveland, OH
  • Location: Cleveland - Store 489: 55 Helen Highway Cleveland GA 30528 Requirements Ideal candidates will possess interper...
  • 3/28/2024 12:00:00 AM

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Nurse Practitioner - Advanced Practice Provider
  • Oak Street Health Inc.
  • Cleveland, OH
  • Title: Nurse Practitioner - Advanced Practice Provider Schedule: Full-Time, Monday through Friday, 8:00 AM - 5:00 PM Loc...
  • 3/28/2024 12:00:00 AM

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Engineering Detailer
  • American Tank & Fabricating Co.
  • Cleveland, OH
  • Engineering Detailer (AutoCAD) | Cleveland, OH Want to build large complex fabrications for submarines? That's one of th...
  • 3/26/2024 12:00:00 AM

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Medical Assistant
  • Concentra Career Choice
  • Cleveland, OH
  • Overview: Are you ready to take your career to new heights? At Concentra, you will be a vital member of our patient care...
  • 3/25/2024 12:00:00 AM

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Medical Assistant
  • Concentra
  • Cleveland, OH
  • Overview: Are you ready to take your career to new heights? At Concentra, you will be a vital member of our patient care...
  • 3/25/2024 12:00:00 AM

Cleveland (/ˈkliːvlənd/ KLEEV-lənd) is a major city in the U.S. state of Ohio, and the county seat of Cuyahoga County. The city proper has a population of 385,525, making it the 51st-largest city in the United States, and the second-largest city in Ohio. Greater Cleveland is ranked as the 32nd-largest metropolitan area in the U.S., with 2,055,612 people in 2016. The city anchors the Cleveland–Akron–Canton Combined Statistical Area, which had a population of 3,515,646 in 2010 and is ranked 15th in the United States. The city is located on the southern shore of Lake Erie, approximately 60 miles ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Policy Specialist jobs
$88,107 to $107,548
Cleveland, Ohio area prices
were up 1.6% 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