Medical / Clinical Policy Reimbursement Writer

Medical / Clinical & Reimbursement Policy Writer

The Medical / Clinical & Reimbursement Policy Writer researches and develops moderate to complex medical, administrative and reimbursement provider policies; ensures adherence to company, state, and federal guidelines.

Essential Functions

• Support the operational processes of the Clinical Provider Policy Governance Committee (CPGC)
• Ensure all new and existing configuration rules are incorporated into the clinical policies
• Responsible for the tactical activities related to the support of CareSource's reimbursement policies
• Provide medical, administrative and reimbursement policies policy deliverables for all lines of business
• Participate in department initiatives and projects
• Ensure all reimbursement policies are compliant with relevant regulations and are consistent across all lines of business (duplicate with clinical policy writer)
• Assist, Identify and define Claims Ops solutions to meet regulatory requirements
• Coordinate with subject matter experts to develop policy on issues that impact CareSource from medical / clinical, and reimbursement policies policy perspectives
• Support cross functional teams with responses and restitution projects
• Remediate gaps in existing processes related to medical, administrative and reimbursement provider policies that do not meet regulatory requirements
• Work with business product owners, government relations, and compliance leads to monitor legislative and regulatory activities for potential impact on existing or proposed policies
• Collaborate with interdisciplinary team members to achieve team goals
• Monitor status reports to ensure effective workflow and timely development of medical, behavioral health, administrative and reimbursement policies
• Perform any other job duties as requested

Education and Experience

Competencies, Knowledge and Skills

Licensure and Certification

Working Conditions

Compensation Range

$70,800.00 - $113,200.00

CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly / salary) : Salary

Organization Level Competencies

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.