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)
Responsibilities:
- Review and process medical billing claims
- Verify accuracy of patient demographic and insurance information
- Ensure compliance with coding and billing regulations
- Resolve billing discrepancies and denials
- Communicate with insurance companies and patients regarding billing inquiries
- Maintain up-to-date knowledge of medical coding systems, such as ICD-10
- Collaborate with medical staff to obtain necessary documentation for accurate coding
Requirements:
- Previous experience working in a medical office or healthcare setting
- Strong knowledge of medical terminology and coding systems
- Proficiency in medical collection processes
- Familiarity with electronic medical records systems
- Attention to detail and accuracy in data entry and record keeping
- Excellent communication skills, both written and verbal
- Ability to work independently and prioritize tasks effectively
Job Type: Full-time
Benefits:
Schedule:
Work setting:
Ability to Relocate:
Work Location: In person
Clear All
0 Medical Policy Specialist jobs found in Norfolk, VA area