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Senior Manager - Payment Policy And Network Coding
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- Collaborates with Government Regulatory Affairs, Network Management, Medical Economics, Benefit Administration, Provider Services, Audit, IT and Claim Operations to determine the impact of implementing policy changes.
- Develop business requirements and change requests to include but not limited to: Actuary/Finance cost analysis, Clinical Editing and Nasco system configuration updates and UAT/QC test cases.
- Demonstrated competence with payment reimbursement policy research and development within a health plan, government agency, regulatory or accreditation body
- Must be proficient in the use of computers, specifically Microsoft Office products Experience with MS Access, Power Point, Cognos Power BI database program and excel
- 7-10+ years directly work in payment reimbursement policy, payment integrity and/or clinical editing
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