Medical Policy Manager jobs in Indiana

Medical Policy Manager manages and implements corporate policy and process for medical provider and other reimbursements. Ensures that all claims are reviewed, settled, and processed in compliance with and according to contract provisions and regulatory requirements. Being a Medical Policy Manager evaluates and develops policies and provider reimbursement guidelines to effectively manage and control medical claims cost. Requires a bachelor's degree of finance, business or healthcare administration. Additionally, Medical Policy Manager typically reports to head of a unit/department. The Medical Policy Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Medical Policy Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)

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Medical Policy Consultant
  • Elevance Health
  • Indianapolis, IN FULL_TIME
  • National Government Services is a proud member of Elevance Health Companies, Inc. family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs.

    Location: This is a virtual position, and preferred candidates reside within 50 miles of an Elevance Health PulsePoint location.

    Shift: Monday - Friday 8 am - 4:30 pm EST.

    The Medical Policy Consultant is responsible for researching and drafting NGS Medical Policy ensuring the use of valid and consistent research methodologies.

    How You Will Make An Impact

    • Conducts structured research within defined methodologies.
    • Drafts and modifies policies using consistent template tools and criteria.
    • Review new and updated codes for accuracy and consistency.
    • Research relevant studies and review articles for the development of local coverage determinations, coverage articles, and coding guidelines and for responses to inquiries from providers.
    • Finalizes issues and ensures implementation of these policies.
    • Works with other internal areas and with the Medical Directors to respond to internal and external requests that seek written clarification of a general or specific policy question. The response may be a reiteration of an established policy a redefinition of the current policy or research to determine a new revised policy.
    • Attendance and understanding of edits via the Edit Effectiveness meetings is a critical skill.
    • Ability to think on your feet and learn the policy consultant job quickly.
    • Scheduling Open Meetings/CACs and informal meeting processes must be learned.
    • Review and respond to OIG, CMS questions, and FOIA requests in a timely fashion.
    • Must be able to formulate a written policy in collaboration with Medical Directors and attend workgroup meetings and weekly CMD/MPU meetings. This must be based on significant research using Hayes and other tools available to the policy team.

    Minimum Requirements

    • Requires a BA/BS degree in a related field and a minimum of 2 years related experience; or any combination of education and experience which would provide an equivalent background.
    • Travels to worksite and other locations as necessary.
    • Working knowledge of coding is required.
    • This position is part of our NGS (National Government Services) division which, per CMS TDL 190275, requires foreign national applicants to meet the residency requirement of living in the United States at least three of the past five years.

    Preferred Skills, Capabilities, And Experiences

    • RN license is preferred.
    • Prior medical literature research experience or related experience is preferred.
    • Technical writing experience preferred.
    • Excellent writing and communication skills and attention to detail as well as a love of research.
    • In-depth knowledge of ICD-10, CPT, and HCPCS codes is preferred.
    • Understanding edits/audits in FISS and MCS is preferred.

    If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a `sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role-specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed. The use of this job is limited to the Federal Government Services business unit.
  • 11 Days Ago

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Manager-Policy and Compliance
  • City of Indianapolis
  • Indianapolis, IN FULL_TIME
  • Position SummaryAgency Summary The purpose and mission of the Metropolitan Emergency Services Agency is to provide operation and management of the Division of Emergency Communications - 911 center, Di...
  • 3 Days Ago

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FARM MANAGER – GAME – FM1499
  • Farm Manager SA
  • River, IN OTHER
  • Limpopo River Area – Limpopo: Our client is looking for a Farm Manager- Game to join the team. Only candidates with the relevant experience will be considered. MINIMUM REQUIREMENTS Agricultural Diplom...
  • 19 Days Ago

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Regional Service Manager - Fort Wayne, IN (Remote)
  • Signode -Regional Service Manager
  • Fort Wayne, IN FULL_TIME
  • Regional Service Manager - Fort Wayne, IN (Remote) Apply Now Description/Job Summary About Signode:With over $2B in revenue, 80 manufacturing facilities across 6 continents and over 9,000 employees wo...
  • 9 Days Ago

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Policy Analyst
  • U.S. Department of the Treasury
  • Carmel, IN FULL_TIME
  • DutiesWHAT IS THE LARGE BUSINESS AND INTERNATIONALDIVISION?A description of the business units can be found at: https://www.jobs.irs.gov/about/who/business-divisionsVacancies Will Be Filled In The Fol...
  • 16 Days Ago

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Marketing Manager
  • Viant Medical
  • Fort Wayne, IN FULL_TIME
  • Position Title: Content Marketing ManagerReports to: Sr. Director of MarketingStatus: Full TimeDescriptionAs the Content Marketing Manager , your responsibilities include leading and integrating marke...
  • 15 Days Ago

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Hospital Medical Leader
  • Petco
  • Fairfield, CA
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 6/10/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco
  • Deerfield Beach, FL
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 6/9/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Noblesville, IN
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 6/9/2024 12:00:00 AM

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Head of Medical Writing
  • Barrington James
  • Clinical-stage biopharmaceutical company in San Francisco, is seeking a Head of Medical Writing. This leadership role in...
  • 6/8/2024 12:00:00 AM

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Head of Medical Strategy
  • ExecuSearch
  • Atlanta, GA
  • The Head of Medical Strategy provides medical expertise to the rheumatology commercial and medical teams and provides cl...
  • 6/8/2024 12:00:00 AM

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Head of Medical Strategy Rheumatology
  • UCB
  • Atlanta, GA
  • Make your mark for patients The Head of Medical Strategy provides medical expertise to the rheumatology commercial and m...
  • 6/8/2024 12:00:00 AM

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Head of Medical Writing
  • Barrington James
  • San Francisco, CA
  • Head of Medical Writing - Rare disease Biotech We are currently partnered with a growing, west coast based biotech focus...
  • 6/7/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies, Inc.
  • Plainview, NY
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 6/7/2024 12:00:00 AM

Indiana /ˌɪndiˈænə/ (listen) is a U.S. state located in the Midwestern and Great Lakes regions of North America. Indiana is the 38th largest by area and the 17th most populous of the 50 United States. Its capital and largest city is Indianapolis. Indiana was admitted to the United States as the 19th U.S. state on December 11, 1816. Indiana borders Lake Michigan to the northwest, Michigan to the north, Ohio to the east, Kentucky to the south and southeast, and Illinois to the west. Before becoming a territory, various indigenous peoples and Native Americans inhabited Indiana for thousands of ye...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Policy Manager jobs
$127,511 to $155,665

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