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)
Shared Services : Risk Management-(Full-Time, Day Shift) -
Job Summary : The Wellness Program Specialist supports the wellness program; provides customer service and monitors employee wellness activities / requirements.
Aids in scheduling, reminders and care follow-up; maintains and organizes records / data. Employee must be an organized team player with good written and verbal communication skills.
Must be able to take direction and receive feedback. Performs other duties as needed.
Education and Experience : High School Diploma or GED required. Associate's Degree preferred. Minimum three years of secretarial / general office or project management experience required.
Knowledge and Skills : Must know the mission and values of the organization and have a working knowledge of Living Whole programs.
Able to read; write legibly; speak in English with professional quality; use computer, printer, and software programs necessary to the position (e.
see adequately to read computer screens, and written documents necessary to the position.
Licensures and Certifications : Valid Driver's License required at time of hire.
Last updated : 2024-03-22
Clear All
0 Medical Policy Specialist jobs found in San Bernardino, CA area