Medical / Clinical Policy Reimbursement Writer

Medical / Clinical & Reimbursement Policy Writer

Job Summary : The Medical / Clinical & Reimbursement Policy Writer researches and develops moderate to complex medical, administrative and reimbursement provider policies; ensures adherence to company, state, and federal guidelines.

Essential Functions :

• Support the operational processes of the Clinical Provider Policy Governance Committee (CPGC)
• Ensure all new and existing configuration rules are incorporated into the clinical policies
• Responsible for the tactical activities related to the support of CareSource's reimbursement policies
• Provide medical, administrative and reimbursement policies policy deliverables for all lines of business
• Participate in department initiatives and projects
• Ensure all reimbursement policies are compliant with relevant regulations and are consistent across all lines of business
• Assist, identify and define Claims Ops solutions to meet regulatory requirements
• Coordinate with subject matter experts to develop policy on issues that impact CareSource from medical / clinical, and reimbursement policies policy perspectives
• Support cross functional teams with responses and restitution projects
• Remediate gaps in existing processes related to medical, administrative and reimbursement provider policies that do not meet regulatory requirements
• Work with business product owners, government relations, and compliance leads to monitor legislative and regulatory activities for potential impact on existing or proposed policies
• Collaborate with interdisciplinary team members to achieve team goals
• Monitor status reports to ensure effective workflow and timely development of medical, behavioral health, administrative and reimbursement policies

Perform any other job duties as requested

Education and Experience :

Competencies, Knowledge and Skills :

Licensure and Certification :

Working Conditions :

Compensation Range : $70,800.00 - $113,200.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary