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Now hiring a Claims Configuration Medical Policy & Coding Specialist. A liaison role in the organization between different departments of the Presbyterian Health Plan (PHP) outpatient services. Manage collaboration among multidisciplinary teams to resolve from beginning to end - which may entail preparation, execution, feedback and resolution of claims, coding and system configuration. Responsible for the research, analysis, planning, implementation, evaluation, and development of Payment Integrity configuration by providing guidance and oversight for translating medical policies into rules that may promulgate from either external purchased criteria or in-house Medical Policy Manuals. Develops processes to meet responsibilities of configuration-based policies to ensure compliance is met and proper edits are in place with configuration departments.
