Title: Medical Policy Implementation Consultant
Pay Rate: Market
Length: 9+ Months
Location: Remote with preference for local candidates to work 2 days in the office in Eagan, MN
Description: Our direct end client is looking for a Medical Policy Implementation Consultant for a 14+ month contract. This position is a key member of the team that develops and implements medical policies for the client. The incumbent will be responsible for ensuring that medical policy issues are circulated to internal stakeholders at several stages before final implementation. They will be part of a team that ensures policies are implemented and integrated with all systems to ensure accurate claims processing, including reviewing and applying new codes to the medical policies, developing quality improvement processes for medical policy implementation, and assisting with data reporting needs related to policy decision making. The incumbent will also organize communication of medical policy changes and serve as a liaison within the Integrated Health Management division for communication of medical policy issues. The Senior Medical Policy Consultant serves as a resource to other members of the Medical Policy team.
Project Overview: The team is implementing an automation tool that codifies medical policies and utilizes AI to automate prior authorization approvals where possible.
Responsibilities:
- Support AuthAI Implementation
- Clinical decision tree validation, ensuring alignment with medical policy
- Testing support post AuthAI implementation
- Present and provide implementation input to key medical policy committees
- Prepare final policy documents and tools for implementation
- Implement medical policies and integrate with systems for accurate claims processing
- Communicate changes in client medical policies to all lines of business
- Research and apply updates of CPT, HCPCS, and ICD-9/ICD-10 coding to the medical policies
Required Experience:
- 5+ years of related professional experience
- Registered Nurse with strong understanding of medical policy interpretation as it relates to prior authorization processing
- Ability to apply critical thinking skills to medical policy interpretation and implementation
- Ability to work independently; well-organized and able to set priorities with minimal direction
- Effective verbal and written communication skills
- Strong PC skills; Excel, PowerPoint, Visio, Word, and internet-based programs
- Ability to manage multiple projects in a fast-paced environment
- Ability to maintain relationships with internal and external stakeholders
- Project management experience
- Demonstrated positive professionalism in work-related behaviors
Nice to have: Degree in a health-related field such as nursing
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