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Job Description
- Req#: 300001867983422
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Competitive compensation and benefits package
- Opportunity for career advancement and growth within the organization
- Work independently in a remote environment
- Engage with a variety of stakeholders and subject matter experts
- Chance to contribute to compliance and regulatory processes that impact health plans
What to Expect (Job Responsibilities):
- Develop and maintain requirement documents related to coverage, reimbursement, and system changes
- Monitor sources to ensure updates align with regulatory baseline requirements
- Lead the development and management of review processes with partner organizations
- Conduct analyses to identify root causes and assist with problem management related to state requirements
- Communicate requirement interpretations and changes to health plans and core functional areas
What is Required (Qualifications):
- At least 2 years of experience in a managed care organization, health insurance, or a directly adjacent field
- Knowledge of policy and government legislative review
- Strong analytical and problem-solving skills
- Proficient in Office Product Suite, including Word, Excel, Outlook, and Teams
- Experience with provider data, PNV file, network adequacy, and SQL
How to Stand Out (Preferred Qualifications):
- Project implementation experience
- Knowledge and experience with federal regulatory policy resources, including CMS and the ACA
- Medical Coding certification
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