Behavioral Health Policy Consultant

Job not on LinkedIn

🔥 46 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $67.9k - $182.5k / year

⏰ Full Time

🟠 Senior

🔴 Lead

💼 Consultant

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• responsible for the identification, development, and execution of behavioral health clinical and payment policies • serve as a subject matter expert (SME) bridging clinical policy, coding, and claims adjudication • partner across Medical Policy, Medical Coding, Compliance, and vendor teams to ensure policy operationalization • define and drive payment policy strategies to ensure accurate claim adjudication and cost containment • own development of detailed Business Requirements Documents (BRDs) • validate that behavioral health policies are correctly translated into system logic and medical coding rules • perform policy QA and validation to ensure alignment between clinical intent and system execution • serve as Behavioral Health SME across Medical Policy governance forums • lead end-to-end policy lifecycle from intake through execution and monitoring

🎯 Requirements

• 7+ years of experience in medical policy, payment policy, or correct coding; behavioral health clinical practice; or utilization management • Ability to interpret behavioral health clinical standards and translate into policy • Apply correct coding frameworks (ICD-10, CPT/HCPCS) in policy and claims contexts • Develop business requirements documents (BRDs) supporting claims system configuration • Strong knowledge of behavioral health services (e.g., psychiatry, SUD, therapy modalities) and medical necessity criteria and utilization management • Experience translating policy into medical coding logic (ICD-10, CPT, HCPCS), claims editing and adjudication rules • Demonstrated experience developing business requirements (BRDs) for system implementation • Experience with claims adjudication platforms and/or vendor editing solutions

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources, based on eligibility