Claims Payment Policy Lead

Pyramid, Inc

Philadelphia, PA

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JOB DETAILS

SALARY

$56–$58 Per Hour

JOB TYPE

Full-time

SKILLS

Business Case, Certified Coding Specialist (CCS), Clinical Competency, Corporate Policies, Cost Control, Cross-Functional, Current Procedural Terminology (CPT), Employee Benefits, Establish Priorities, Health Insurance, Healthcare Common Procedure Coding System (HCPCS), Healthcare Reimbursement, International Classification of Diseases (ICD), Leadership, Medical Coding, Medicare, Mentoring, Organizational Skills, Pattern Analysis, Presentation/Verbal Skills, Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Registered Nurse (RN), Regulations, Reimbursement, Revenue Management, Support Documentation, Team Lead/Manager, Time Management, Writing Skills

LOCATION

Philadelphia, PA

POSTED

12 days ago

Immediate need for a talented Claims Payment Policy Lead. This is a 03 months contract opportunity with long-term potential and is located in Philadelphia, PA (Remote). Please review the job description below and contact me ASAP if you are interested.Job ID: 26-17715Pay Range: $56 - $58/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).Key Responsibilities: Shift: Day Shift Lead cross-functional collaborations with key business areas to generate policy driven innovative medical cost savings ideas, validate feasibility, and execute successful implementation. Monitor industry trends, regulatory changes, and reimbursement practices to ensure compliance and alignment with organizational goals. Develop and maintain claim payment policies that reflect nationally recognized reimbursement practices in accordance with Company benefit, contracting and reimbursement structures, state and federal mandates and other appropriate sources. Develop and maintain select medical policies adapted from Company recognized sources in accordance with Company benefits, state and federal mandates, and other appropriate sources. Present Policy Bulletins to appropriate workgroups and committees and revise documents according to recommendations. Apply appropriate coding sources to recommend and develop comprehensive code assignments in accordance with established coding guidelines. Develop, prepare and present detailed business requirement documents to support policy and coding initiatives. Evaluate and analyze utilization patterns and other sources of information to make recommendations for appropriate and cost-effective utilization. Develop business cases to assist with decision making for assigned initiatives. Mentor other staff and serve as coding and/or clinical SME and represent the department in a variety of forums. Interact with all levels of associates and management within the Company and with outside contractors, consultants and other organizations. Performs additional related duties as assigned.Key Requirements and Technology Experience: Bachelor's degree in relevant discipline or equivalent work experience. Current coding certification (CCS, CPC, RHIA, RHIT), or current coding certification in combination with a clinical licensure (e.g., RN). Minimum of five years related work experience with evidence of a broad base of knowledge and application of the revenue cycle management process and medical code sets, including CPT, HCPCS, and ICD-10. Knowledge of healthcare reimbursement concepts, health insurance business, industry terminology, and regulatory guidelines. Familiarity with Medicare rules and regulations. Excellent organizational, time management, presentation, verbal, written and analytical skills and demonstrated ability to develop and lead cross-functional teams. Must be able to work independently, prioritize workload, meet deadlines, and to assess the criticality of issues.Our client is a leading Healthcare and Health Insurance Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.#tel

Claims Payment Policy Lead

Pyramid, Inc

Philadelphia, PA

About the Company

Pyramid, Inc

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