Job ID: J114789
Company: Highmark Inc
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
This job owns the full-cycle commercial medical policies, both developed internally and by vendors. This includes the writing of clinical criteria based on research, engagement of non-clinical team members for operational guidelines, and ownership of the publishing process. The incumbent must have an understanding of medical coding (ICD-10, CPT, HCPS) as medical coding based off of policy criteria falls in their scope. In addition to developing new policies, the incumbent ensures all existing medical policies, in their scope, are up to date which may involve revisions in response to escalated inquiries brought forward by internal/external partners. Conducts peer reviews as part of the quality review process. In addition to policy ownership, the incumbent participates on various work-groups and sub-committees as clinical leads/experts. Trains and orients new staff to the department and policy procedures, and mentors new team members. Serves as a liasion between other departments and vendors as required.
LICENSES OR CERTIFICATIONS
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