Certified Medical Policy Specialist

Job Summary

A company is looking for a Medical Policy Professional, Mid - Full-time (Remote U.S. within Alaska Time Zone Hours).

Key Responsibilities

• Serve as the main point of contact for configuring medical policy solutions and integrating service agreements from external vendors
• Oversee system settings related to cap limits and medical review triggers, ensuring proper routing for reviews
• Collaborate with internal teams and external partners to maintain compliance and accuracy in medical policy applications

Required Qualifications

• Available to work business hours as defined by contract within the Alaska Time Zone
• Bachelor's degree in a related field (e.g., Health Information Management, Public Health, Healthcare Administration, Nursing)
• Certified Coding Specialist (CCS) credential from the American Health Information Management Association (AHIMA)
• 5+ years of experience in developing and managing medical policy or Utilization Management (UM) policy for state Medicaid agencies or Medicare
• Strong knowledge of CMS coding systems, including procedure codes and diagnostic codes