Pennsylvania Licensed Claim Policy Lead

Job Summary

Leading the development and implementation of innovative medical cost savings initiatives, the full-time salaried Pennsylvania Licensed Claim Policy Lead will work remotely to generate policy-driven reimbursement strategies and ensure compliance with industry regulations.

Key responsibilities

• Lead cross-functional collaborations to generate and implement medical cost savings ideas
• Develop and maintain claim payment policies in alignment with reimbursement practices and regulatory standards
• Present Policy Bulletins and mentor staff while serving as a coding and clinical subject matter expert

Required qualifications

• Bachelor's degree in a relevant discipline or equivalent work experience
• Current coding certification (CCS, CPC, RHIA, RHIT) or a combination of coding certification and clinical licensure
• Minimum of five years of related work experience in revenue cycle management and medical code sets
• Knowledge of healthcare reimbursement concepts and familiarity with Medicare rules and regulations
• Demonstrated ability to develop and lead cross-functional teams effectively