| Medical Policy Specialist Job Description |
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| The following is a full job description for Medical Policy Specialist. Here are the requirements and responsibilities for Medical Policy Specialist along with statistics. If after reading this page you determine that Medical Policy Specialist is not the position you are looking for, you may want to try one of these similar titles: Medical Billing Specialist, Medical Policy Manager, Medical Records Coding Policy Administrator, Medical Records Coding Compliance Specialist, Medical Staff Credentialing Specialist, Medical Staff Credentialing Specialist, Sr., Drug Safety/Medical Information Specialist IV, Policy Change Supervisor, New Policy Specialist |
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| Requirements and Responsibilities For Medical Policy Specialist |
| 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. |
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| Also referred to as: Provider Claims Process and Controls Analyst |
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| Similar Jobs: Medical Billing Specialist, Medical Policy Manager, Medical Records Coding Policy Administrator, Medical Records Coding Compliance Specialist, Medical Staff Credentialing Specialist, Medical Staff Credentialing Specialist, Sr., Drug Safety/Medical Information Specialist IV, Policy Change Supervisor, New Policy Specialist |
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| Level of Education: Medical Policy Specialist Salaries with a Bachelor's Degree, Medical Policy Specialist Salaries with a Master's Degree or MBA, Medical Policy Specialist Salaries with a JD, MD, PhD or Equivalent |
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| Industries: Edu., Gov't. & Nonprofit, Healthcare, Insurance | |
