CLIENT POLICY MANAGER iHealth Technologies, Inc.
PRINCIPLE PURPOSE OF THE JOB
The Client Policy Manager I manages client payment policies by ensuring client?s payment policy is accurate, up-to-date and complete. Ensuring execution of client specific requests and acting as the internal and external client team liaison.
ESSENTIAL JOB RESPONSIBILITIES:
Reviews all documents and coordinates reviews with the Medical Directors
Conducts research and analysis for medical policy items
Primarily responsible for the integrity of the client's medical policy rule set, including awareness of all client-related Medical Policy Project Requests, monthly review of Max Units, review of Health Plan rules, etc.
Primary driver of the Periodic Update Analysis and participates in monthly/quarterly client policy meetings:
Reviews clients payment policies for accuracy
Completes reviews on a timely basis
Clearly understands and articulates medical policies
Presents the policies for review and acceptance by the client
Provides direction on client understanding of medical policies
Adds value to Medical Policy and client teams:
Participates on Medical Policy and client teams
Offers benefit of knowledge and experience proactively
Communicates effectively with various members of the client team (internal as well as external)
Responsible for translating industry references into iHT policy
Reviews and identifies changes needed to client policies in order to maintain up-to-date and accurate medical payment policies.
Performs multi-faceted analytics in all data and report analysis
Applies project management principles in initiating, creating and managing projects
Reviews and analyzes client inquiries for clarity of intent, applying decisions for affected policies, maintaining information and communicating effectively with the client.
Other Related Responsibilities
Other duties as assigned
Working knowledge of iHT systems
Demonstrates basic working knowledge of less than three of the following applications: CDM (working PUR, creating adhoc presentation, capturing decisions, create NPP presentation), eLL, RMI, RMR, Business Objects Reporting and SQUISH.
Experience in customer service or client management with a strong focus on healthcare setting.
RHIT, RHIA, CCS, CPC certifications preferred
Strong Knowledge of CMS guidelines
Health plans, Managed Care or Health Care insurance company experience
Prior experience in developing medical payment policy edits
Experience in claims adjudication or utilization review working for a managed care or healthcare insurance company
Effective problem solving skills
Professional with ability to properly handle confidential information.
Ability to work well independently and in a team environment.
Ability to handle multiple tasks, prioritize and meet deadlines.
Excellent written and verbal communication skills.
Exhibits behaviors consistent with iHT Values.
Bachelors Degree Preferred
Experience in claim payment adjudication or medical payment policy.
Experience in CPT-4, ICD-9-CM and HCPCS coding.
Professional coder certification (CPC,CPC-H, CPC-P or CCS-P) or LPN or RN with medical coding knowledge.
Proficient in Microsoft Office Excel, Word and Powerpoint.
Must be able to sit and use a computer keyboard for extended periods of time.
After hours and/or weekend work may be required where necessary for major deliverables/deadlines (not consistent).
Travel requirement up to 25%
This position has no direct reports.
Client Business Support Analysts
External: Client Medical Directors, Client Payment Policy personnel
||Altanta, GA |