Medical Policy Reimbursement Writer

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November 20

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CareSource

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Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

1001 - 5000 employees

Founded 30+ years

⚕️ Healthcare Insurance

📋 Description

• Researches and develops moderate to complex medical, administrative and reimbursement provider policies • Ensures adherence to company, state, and federal guidelines • Supports the operational processes of the Clinical Provider Policy Governance Committee (CPGC) • Ensures 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 • Provides medical, administrative and reimbursement policies policy deliverables for all lines of business • Participates in department initiatives and projects • Ensures all reimbursement policies are compliant with relevant regulations and are consistent across all lines of business • Assists, identifies and defines Claims Ops solutions to meet regulatory requirements • Coordinates with subject matter experts to develop policy on issues that impact CareSource from medical/clinical, and reimbursement policies policy perspectives • Supports cross functional teams with responses and restitution projects • Remediates gaps in existing processes related to medical, administrative and reimbursement provider policies that do not meet regulatory requirements • Works with business product owners, government relations, and compliance leads to monitor legislative and regulatory activities for potential impact on existing or proposed policies • Collaborates with interdisciplinary team members to achieve team goals • Monitors status reports to ensure effective workflow and timely development of medical, behavioral health, administrative and reimbursement policies

🎯 Requirements

• Bachelor’s Degree or equivalent years of relevant work experience is required • Technical writing experience is required, preferably healthcare policy or related • Previous managed care experience to include experience with medical coding, claims payment, and/or retrospective claims reviews is preferred • Ability to develop detailed data specifications • Knowledge of Clinical Editing applications • Understanding of Healthcare Economics • Knowledge of NCQA policy timely requirements • Strong understanding of healthcare reimbursement practices • Ability to translate ideas into clear and concise written communication • Computer skills/proficiency level with Microsoft Word, Excel, search engines, and bibliographic software • Knowledge of medical terminology and claims payment policies • Advanced analytical skills, with the ability to interpret and synthesize complex healthcare literature • Ability to interpret complex clinical information and apply to policy development • Excellent verbal and written communications skills • Strong presentation and decision-making skills • Excellent organization and tracking skills • Good problem-solving skills • Ability to interface with employees at all levels • Ability to handle multiple priorities/projects simultaneously

🏖️ Benefits

• Health insurance • Retirement plans • Paid time off • Flexible work arrangements • Professional development • Bonuses