Policy Coordinator (Hybrid)

CareFirst•Baltimore, MD

5d•Hybrid

About The Position

The Policy Coordinator supports the end-to-end implementation of medical policies by coordinating cross-functional activities required to operationalize policy decisions. This role supports policy governance, business readiness, implementation, provider communication activities, and post-implementation validation to ensure medical policy changes are effectively implemented across impacted business functions. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week.

Requirements

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.
Experience in health plan operations, project coordination, policy implementation, claims operations, or related functions.
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.
Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Must be eligible to work in the U.S. without Sponsorship.

Nice To Haves

Certified Coder (CCS or CPC)-AHIMA or AAPC
AAPC Certified Professional Coder (CPC) or AHIMA Certified Coding Specialist (CCS)
Experience working in a health plan environment (Medical Policy, Payment Policy, Claims, or Operations).
Experience coordinating cross-functional projects or implementations.
Familiarity with claims systems, configuration processes, or policy governance.

Responsibilities

Coordinates cross-functional activities required to implement medical policy changes, including alignment across impacted operational and business areas.
Tracks key milestones, implementation dependencies, and readiness activities to ensure successful policy go-live and ongoing policy maintenance.
Supports business readiness and policy governance activities, including impact assessments, readiness checklists, and coordination of implementation plans.
Works with stakeholders to identify operational, staffing, system, compliance, and workflow impacts associated with policy changes.
Coordinates testing and validation activities related to policy implementation, including user acceptance testing (UAT), implementation validation, and issue tracking and resolution.
Ensures testing results are documented and communicated to stakeholders.
Maintains implementation documentation, including timelines, status reports, risks, dependencies, readiness materials, and action items.
Provides regular updates to leadership and stakeholders and supports transparency across teams.
Supports post-implementation monitoring by coordinating issue tracking, identifying gaps in execution, and escalating risks or defects to appropriate stakeholders for resolution.
Supports continuous improvement efforts related to policy implementation and operational effectiveness.