Responsible for the accurate and timely intake and interpretation of regulatory and functional requirements related to coverage, reimbursement, and processing functions. The role supports systems solution development and maintenance, coordinates with stakeholders and subject matter experts, and helps guide governance and review processes.
- Develop and maintain requirement documents for coverage, reimbursement, and system changes.
- Monitor sources to ensure updates remain aligned with regulatory and health plan requirements.
- Lead coordinated development and ongoing interpretation review processes with partner organizations.
- Conduct analysis to identify root causes and support problem management related to state requirements.
- Communicate requirement interpretations and changes to health plans, product teams, and corporate functions.
- Support inconsistency resolution, complaints, and reporting around requirement changes.
- Work independently in a remote environment and collaborate across time zones.
Requirements & Qualifications
- At least 2 years of experience in a managed care organization, health insurance, or a directly adjacent field, or equivalent education and experience.
- Knowledge of policy and government legislative review.
- Strong analytical and problem-solving skills.
- Proficiency with Microsoft Word, Excel, Outlook, and Teams.
- Previous success in a dynamic, autonomous work environment.
- Ability to work independently in a remote setting and across multiple time zones.
- Preferred: project implementation experience.
- Preferred: knowledge of CMS and ACA regulatory policy resources.
- Preferred: medical coding certification.
Benefits & Perks
- Competitive benefits and compensation package.
Location
N/A
Employment Type
Full-time
Experience Level
Associate
Salary Range
$44,937 - $97,363
Remote work allowed
Yes
Posted
1 month ago
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