Payment and Medical Policy Coordinator (Remote)

PURPOSE

The Policy Coordinator will support the end-to-end implementation of medical and payment policies by coordinating cross-functional activities required to operationalize policy decisions. This role ensures business readiness across impacted functions, including claims, configuration, provider communications and operations, and provides support during testing, implementation, and post-implementation validation.

Essential Functions

• Cross-coordinates cross-functional activities required to implement medical and payment policy changes, including alignment across claims, configuration, provider operations, network management, and compliance teams.
• Tracks key milestones and ensures readiness for policy go-live.
• Supports business readiness activities, including impact assessments, readiness checklists, and coordination of implementation plans.
• Works with stakeholders to identify operational, staffing, and workflow impacts associated with policy changes.
• Collaborates on testing activities related to policy implementation, including user acceptance testing (UAT), validation of claims adjudication logic, and issue tracking/resolution.
• Maintains implementation documentation, including timelines, status reports, risks, and dependencies.
• Provides regular updates to leadership and ensures transparency across teams.
• Sustains post-implementation monitoring by coordinating issue tracking, identifying gaps in execution, and escalating risks or defects to appropriate stakeholders for resolution.

Qualifications

• Education Level: Bachelor's Degree in Health Administration, Business, Finance or related discipline OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
• Licenses/Certifications: Preferred Certified Coder (CCS or CPC)-AHIMA or AAPC AAPC Certified Professional Coder (CPC) or AHIMA Certified Coding Specialist (CCS).
• Experience: Experience in health plan operations, project coordination, policy implementation, claims operations, or related functions.
• Preferred Qualifications: Experience working in a health plan environment (Medical Policy, Payment Policy, Claims, or Operations).
• Experience: Experience coordinating cross-functional projects or implementations.
• Familiarity: Familiarity with claims systems, configuration processes, or policy governance.

Knowledge, Skills And Abilities (KSAs)

• Strong Organizational and Coordination Skills: Across multiple teams and stakeholders.
• Ability to Manage Multiple Workstreams and Meet Deadlines:
• Strong Communication Skills: With ability to translate policy decisions into operational tasks.
• Working Knowledge: Of managed care, claims processes, and policy implementation workflows.
• Ability to Identify Risks, Track Issues, and Escalate Appropriately:
• Use of Microsoft Office Applications (Excel, PowerPoint, Word) and Project Tracking Tools:

Salary Range

$51,264 - $101,816

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Physical Demands

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.