Medical Clinical Reimbursement Policy Writer

February 27

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CareSource

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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.

Medicaid • MyCare Ohio • Health Insurance Marketplace • Medicare Advantage • Health Insurance

1001 - 5000 employees

Founded 30+ years

⚕️ Healthcare Insurance

📋 Description

• The Medical/Clinical & Reimbursement Policy Writer researches and develops provider policies • Ensures adherence to company, state, and federal guidelines • Support the operational processes of the Clinical Provider Policy Governance Committee (CPGC) • Responsible for the tactical activities related to the support of CareSource’s reimbursement policies • Provide medical, administrative and reimbursement policies for all lines of business • Participate in department initiatives and projects • Ensure all reimbursement policies are compliant with relevant regulations • Assist, Identify and define Claims Ops solutions to meet regulatory requirements • Work with business product owners, government relations, and compliance leads • Collaborate with interdisciplinary team members to achieve team goals • Perform any other job duties as requested

🎯 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 • Healthcare experience strongly 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

• Substantial and comprehensive total rewards package