Medical Policy Coordinator
Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health.
At IBX, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
JOB DESCRIPTION MEDICAL POLICY COORDINATOR
The Medical Policy Coordinator is responsible for the process of developing and maintaining new and existing medical policies which conform to accepted medical practice standards and in accordance with evidence-based principles of medicine, Company benefit structure, state and federal mandates and other appropriate sources.
DUTIES AND RESPONSIBILITIES:
1. Develops and maintains new and existing medical policies conforming to accepted medical practice standards and in accordance with internal department policies and procedures.
a. Tracks policy development requests at time of receipt and updates tracking data bases through the various stages of review. Assists with prioritization of requests for policy development.
b. Researches benefit structure as well as state and federal mandates for assigned topics.
c. Discusses findings with Medical Policy Manager and other members of the Medical and Claim Payment Policy Department management team, as appropriate.
d. Drafts medical policy bulletins in accordance with internal department policies and procedures. Considers product requirements and benefit structure during policy development process.
e. Presents Medical Policy Bulletins to appropriate workgroups and committees and revises documents according to recommendations.
2. Responds to medical policy inquiries from associates of the Company, subsidiaries and risk partners.
3. Participates in the review of new and revised code sets to establish medical necessity in order to guide claim system mapping.
4. Helps establish goals for each project and seeks feedback on performance. Ensures that project tasks are scheduled and completed in an accurate and timely manner in accordance with established project plans.
5. Maintains detailed knowledge of the status of all projects and routinely updates Medical Policy Manager and other members of the Medical and Claim Payment Policy Department management team, as appropriate.
6. Serves as a liaison to other departments of the Company and represents the department at meetings and on work groups as assigned by management. Leads multidisciplinary workgroups to resolve complex issues as required. Participates in Medical Policy Advisory Committee
7. Interacts with all levels of management within the Company and with outside consultants and other organizations.
8. Participates and responds to Medicare Advantage Policy Monitoring
9. Performs additional related duties as assigned.
KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:
1. Bachelor's degree in a clinical healthcare discipline. BSN is preferred. Clinical licensure required; PA registered nursing license preferred.
2. Minimum of three years related work experience in a clinical healthcare discipline.
3. In depth knowledge of all IBC product lines and managed care programs.
4. Demonstrated ability to manage cross-functional deadline-oriented projects to a successful conclusion.
5. Experience in leading and participating on multidisciplinary work groups.
6. Advanced knowledge of word processing, spreadsheet, Internet and e-mail software.
7. Excellent organizational, time management, presentation, verbal and written communication skills.
8. Detail oriented with the ability to work with minimal supervision as well as work well with others.
9. Demonstrated project management skills is preferred.
Hybrid
Independence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey or Pennsylvania.
Diversity, Equity, and Inclusion
At Independence, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
About Our Company
Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!
Equal Employment Opportunity
Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an Independence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.