| Medical Policy Manager Job Description |
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| The following is a full job description for Medical Policy Manager. Here are the requirements and responsibilities for Medical Policy Manager along with statistics. If after reading this page you determine that Medical Policy Manager is not the position you are looking for, you may want to try one of these similar titles: Medical Affairs Manager, Medical Affairs Senior Manager, Medical Policy Specialist, Medical Records Coding Policy Administrator, Credit Policy Manager, Medical Scientific Liaison Manager, Health Policy Sales Manager, Medical Affairs Specialist III, Medical Affairs Specialist IV |
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| Requirements and Responsibilities For Medical Policy Manager |
| Manages the team responsible for administering the clinical coverage guidelines that determine if medical services, technologies, and/or drugs are covered by an insurance plan. Ensures that all claims are reviewed, settled, and processed in compliance with and according to contract provisions and regulatory requirements. Confirms 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 director. Manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Typically requires 5 years experience in the related area as an individual contributor. 1-3 years supervisory experience may be required. Extensive knowledge of the function and department processes. |
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| Also referred to as: Provider Claims Process and Controls Manager |
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| Similar Jobs: Medical Affairs Manager, Medical Affairs Senior Manager, Medical Policy Specialist, Medical Records Coding Policy Administrator, Credit Policy Manager, Medical Scientific Liaison Manager, Health Policy Sales Manager, Medical Affairs Specialist III, Medical Affairs Specialist IV |
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| Level of Education: Medical Policy Manager Salaries with a Bachelor's Degree, Medical Policy Manager Salaries with a Master's Degree or MBA, Medical Policy Manager Salaries with a JD, MD, PhD or Equivalent |
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| Industries: Edu., Gov't. & Nonprofit, Healthcare, Insurance | |
