Implement & Coding Consultant
Core
Leading the development, implementation, and evaluation of Corporate Medical Policy coding strategies across the enterprise.
Role type
Senior IC medical policy coding consultant
Builds
Enterprise medical policy coding strategies and adjudication system configurations
Domain
Healthcare / Medical Policy / Health Insurance
Required skills
Medical policy development, coding strategy implementation, adjudication system optimization, clinical criteria review, CMS/AMA coding updates, quality assurance for code assignment, stakeholder collaboration, process improvement
Preferred skills
Certified Professional Coder (CPC), experienced reviewing clinical criteria and assigning codes
Technologies
CMS, AMA, MPTAC, Document Management System (DMS)
Responsibilities
Conceptualize implementation approaches for policy coding; assess business and technical factors to recommend optimal coding options; optimize enterprise solutions balancing clinical, coding, systems, cost, and provider relations; communicate and monitor execution of policy implementation; support medical policy and clinical UM guideline development; develop quality assurance processes for accurate code assignment; compile and classify quarterly coding updates; provide coding analysis and respond to inquiries; manage and facilitate Coding & Implementation meetings; maintain the Document Management System; improvise processes to standardize performance.
Seniority
Senior, hands-on IC
