Independence Blue Cross · 1 month ago
Claim Payment Policy Lead - Remote (PA/NJ/DE)
United States
Full-time
Remote
Lead/Staff
5+ years expIndependence Blue Cross is focused on renewing and reimagining the future of health care. The Claim Payment Policy Lead is responsible for generating innovative medical cost opportunities and developing reimbursement policies while collaborating with various business areas.
HealthcareHealth InsuranceProperty & Casualty InsuranceHealth CareInsuranceMedical
Responsibilities
Lead cross-functional collaborations with key business areas to generate policy driven innovative medical cost savings ideas, validate feasibility, and execute successful implementation
Monitor industry trends, regulatory changes, and reimbursement practices to ensure compliance and alignment with organizational goals
Develop and maintain claim payment policies that reflect nationally recognized reimbursement practices in accordance with Company benefit, contracting and reimbursement structures, state and federal mandates and other appropriate sources
Develop and maintain select medical policies adapted from Company recognized sources in accordance with Company benefits, state and federal mandates, and other appropriate sources
Present Policy Bulletins to appropriate workgroups and committees and revise documents according to recommendations
Apply appropriate coding sources to recommend and develop comprehensive code assignments in accordance with established coding guidelines
Develop, prepare and present detailed business requirement documents to support policy and coding initiatives
Evaluate and analyze utilization patterns and other sources of information to make recommendations for appropriate and cost-effective utilization
Develop business cases to assist with decision making for assigned initiatives
Mentor other staff and serve as coding and/or clinical SME and represent the department in a variety of forums
Interact with all levels of associates and management within the Company and with outside contractors, consultants and other organizations
Performs additional related duties as assigned
Qualification
Required
Bachelor's degree in relevant discipline or equivalent work experience
Current coding certification (CCS, CPC, RHIA, RHIT), or current coding certification in combination with a clinical licensure (e.g., RN)
Minimum of five years related work experience with evidence of a broad base of knowledge and application of the revenue cycle management process and medical code sets, including CPT, HCPCS, and ICD-10
Knowledge of healthcare reimbursement concepts, health insurance business, industry terminology, and regulatory guidelines
Familiarity with Medicare rules and regulations
Excellent organizational, time management, presentation, verbal, written and analytical skills and demonstrated ability to develop and lead cross-functional teams
Must be able to work independently, prioritize workload, meet deadlines, and to assess the criticality of issues
Company
Independence Blue Cross
The leading health insurer in southeastern Pennsylvania. It is a sub-organization of Independence Blue Cross.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Alexandra Jorgensen
Senior Vice President Human Resources
Joe Geist
SVP & Market President, National
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