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)
This is a remote position.
The training hours are Monday-Friday from 8:00am - 5:00pm (CST time zone) for the three two weeks.
The working hours are Monday-Friday from 8:00am-4:30pm AZ MST OR 8:30am - 5:00pm AZ MST (Arizona MST time zone). (This schedule will begin after the first 3 weeks of training.)
If you are a creative and flexible problem-solver who wants to be an advocate for our patients and be part of a passionate team in a dynamic industry, this job is for you.
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