Claim Payment Policy Lead - Remote (PA/NJ/DE)

Duties And Responsibilities

• Lead cross-functional collaborations with key business areas to generate policy driven innovative medical cost savings ideas, validate feasibility, and execute successful implementation.
• Monitor industry trends, regulatory changes, and reimbursement practices to ensure compliance and alignment with organizational goals.
• Develop and maintain claim payment policies that reflect nationally recognized reimbursement practices in accordance with Company benefit, contracting and reimbursement structures, state and federal mandates and other appropriate sources.
• Develop and maintain select medical policies adapted from Company recognized sources in accordance with Company benefits, state and federal mandates, and other appropriate sources.
• Present Policy Bulletins to appropriate workgroups and committees and revise documents according to recommendations.
• Apply appropriate coding sources to recommend and develop comprehensive code assignments in accordance with established coding guidelines.
• Develop, prepare and present detailed business requirement documents to support policy and coding initiatives.
• Evaluate and analyze utilization patterns and other sources of information to make recommendations for appropriate and cost-effective utilization.
• Develop business cases to assist with decision making for assigned initiatives.
• Mentor other staff and serve as coding and/or clinical SME and represent the department in a variety of forums.
• Interact with all levels of associates and management within the Company and with outside contractors, consultants and other organizations.

Knowledge, Skills, And Abilities Required

• Bachelor's degree in relevant discipline or equivalent work experience.
• Current coding certification (CCS, CPC, RHIA, RHIT), or current coding certification in combination with a clinical licensure (e.g., RN).
• Minimum of five years related work experience with evidence of a broad base of knowledge and application of the revenue cycle management process and medical code sets, including CPT, HCPCS, and ICD-10.
• Knowledge of healthcare reimbursement concepts, health insurance business, industry terminology, and regulatory guidelines.
• Familiarity with Medicare rules and regulations.
• Excellent organizational, time management, presentation, verbal, written and analytical skills and demonstrated ability to develop and lead cross-functional teams.
• Must be able to work independently, prioritize workload, meet deadlines, and to assess the criticality of issues.

Knowledge and Experience

• Full-time remote position.
• Designated by Independence as fully remote.
• The incumbent will not be required to report to one of Independence’s physical office locations to perform the work.
• Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.