Medical Policy Specialist Jobs

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. Establishes the proper codes to use for claims processing. Responds to questions from medical staff and communicates details about policy and guidelines. Requires a bachelor's degree. Typically reports to a supervisor or manager. Requires Registered Nurse RN. Gains exposure to some of the complex tasks within the ... job function. Occasionally directed in several aspects of the work. Typically requires 2 to 4 years of related experience. More
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