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)
Analyze claims prior to submission to ensure accurate processing. Proactively follow up with insurance company for payment, corrected claims, and appeal processes. Work closely with Practice Manager to identify trends with charges and payments as a direct result of the insurance carrier adjudicating claims improperly. Ensure refunds are done timely and in accordance with individual insurance contracts.
This position requires an experienced Medical Biller.
Job Type: Full-time
Pay: $40,000.00 - $48,000.00 per year
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Work Location: In person
0 Medical Policy Specialist jobs found in Reno, NV area