Job ID: J128583
Company: Highmark Inc
Location: Home, PA, United States
Facility: Work From Home
Full/Part Time: Full time
Job Type: Regular
Posted at: Aug 8, 2018
This job prepares market level analysis, conducts medical policy research, pulls journals, and checks mandates for the non-clinical aspect of the commercial policy development. The incumbent owns the development of the operational guidelines, and works with internal Health Plan partners to communicate the guidelines to ensure claims are processed accurately. In addition to the commercial policy responsibilities, the incumbent has ownership of the Medicare Advantage policies. Regularly interprets updates from CMS against existing policies and determines whether changes are required. If changes are necessary, updates the policies per the CMS guidelines and publishes the updated policies. The incumbent completes project work and conducts peer reviews to check for grammar and accuracy as part of the quality review process. May conduct analyses on policies to track members impacted and cost, as well as conduct research on claims that may in turn trigger policy changes/updates.
LICENSES OR CERTIFICATIONS
Language Requirement (other than English)
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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