Clinical Policy Configuration Specialist
Core
Configure and maintain medical coverage policies within a clinical intelligence platform to ensure accuracy, consistency, and compliance with industry standards.
Role type
Clinical Policy Configuration Specialist
Builds
Medical coverage policy configurations and prior authorization criteria within a health technology platform
Domain
Healthcare / Health Technology / Utilization Management
Required skills
Medical coverage policy configuration, Prior authorization criteria, Healthcare data structures, Clinical coding (ICD-10, HCPCS, CPT), Quality assurance and validation, Cross-functional collaboration
Preferred skills
Experience in health technology assessment, Payer policy configuration
Technologies
Microsoft Word, Excel, Google Drive, Confluence, Jira
Responsibilities
Configure and maintain medical coverage policies, Conduct quality assurance reviews and testing of policy configurations, Monitor updates on medical coverage policies, Address customer inquiries regarding policy configurations, Collaborate with clinical experts and product teams to optimize policy implementation
Seniority
Mid-level, hands-on IC