Client Policy Manager I

Job Summary

Required Qualifications

• •Active professional license as a Registered Nurse (BSN preferred) or Bachelor's Degree in Healthcare related field or relative experience
• •Professional coder certification (CPC, CPC-H, CPC-P or CCS-P)
• •Minimum of 3 years clinical coding experience, preferable in a payer setting
• •Strong knowledge of healthcare claims payment policy and processing, specifically, CMS, Medicaid, ICD, CPT, HCPCS and other specialty society, etc.
• •Experience in claims adjudication or utilization review working for a managed care or healthcare insurance company
• •Familiarity with claims payment and reimbursement methodologies
• •Experience in customer service or client management with a strong focus on healthcare setting
• •Clearly understands and articulates medical policies
• •Strong Knowledge of CMS guidelines
• •Prior experience in developing medical payment policy edits
• •Proficiency in Microsoft Office suite
• •Demonstrated problem-solving skills
• •Professional with ability to properly handle confidential information
• •Ability to work well both independently and collaboratively, in a fast-paced and demanding environment
• •Ability to analyze data and synthesize it for customer and internal consumption
• •Effective verbal and written communication, and interpersonal skills
• •Effective at managing timelines and multiple projects with the ability to prioritize and meet deadlines
• •Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones
• •Must be able to perform duties with or without reasonable accommodation
• •Communicating with others to exchange information
• •Assessing the accuracy, neatness, and thoroughness of the work assigned
• •This remote role can be located anywhere in the continental US
• •Travel requirement up to 20%
• •Must be able to lift up to 20 lbs without assistance
• •After-hours and/or weekend work may be required where necessary for major deliverables /deadlines
• •Must be able to sit and use a computer keyboard for extended periods
• •Remaining in a stationary position, often standing or sitting for prolonged periods
• •Repeating motions that may include the wrists, hands, and/or fingers
• •Must be able to provide a dedicated, secure work area
• •Must be able to provide high-speed internet access/connectivity and office setup and maintenance

Desired Qualifications

• •BSN preferred
• •preferable in a payer setting