Payment Policy Program Manager

4 days ago

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WVU Medicine

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neurosurgery • pediatrics • emergency medicine • cardiothoracic surgery • cancer services

10,000+ employees

⚕️ Healthcare Insurance

Description

• Manage, review, and maintain the CES edit library. • Develop and maintain payment policies relating to claim edits. • Lead and participate in workgroups to review proposed changes or new edits. • Monitor and analyze changes in healthcare regulations and payment systems. • Provide documentation to internal departments for provider education. • Respond to provider inquiries on payment disputes. • Track and analyze edit data to create efficiencies. • Manage vendor relationships. • Provide guidance and training to internal teams on payment policy changes. • Conduct regular audits and reviews of payment policies. • Prepare and present reports on payment policy initiatives. • Represent the company in industry forums and regulatory meetings.

Requirements

• Bachelor’s Degree in a related field or equivalent training and experience • Five (5) years in claims processing, payment policy, or claims editing management related experience or • High school diploma or equivalent and eight (8) years in related experience • Certification in RHIT, RHIA, COC, CCS, or CPC. • Certified Professional Coder (CPC) • Medical chart review/auditing experience • Knowledge of Medicare, Medicaid, and Commercial coding rules • Experience using EPIC Tapestry • Extensive background of ICD-10 and CPT coding procedures • Experience working with industry standard methods of payments