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Cross River
Fort Lee, NJ, United States
Who We Are Cross River is a highly profitable, fast-growing financial technology company powering the future of financial services. Our comprehensive suite of innovative and scalable embedded payments, cards, and lending products deliver financial services for millions of businesses and consumers around the globe. Cross River is backed by leading
Job Source: Cross RiverCross River
Fort Lee, NJ, United States
Who We Are Cross River is a highly profitable, fast-growing financial technology company powering the future of financial services. Our comprehensive suite of innovative and scalable embedded payments, cards, and lending products deliver financial services for millions of businesses and consumers around the globe. Cross River is backed by leading
Job Source: Cross RiverBarclays
New York, NY, United States
Payments Product Manager New York As a Barclays Payments Product Manager, you will join the Product Management Group within Transaction Banking. This is an opportunity to develop an in-depth knowledge and understanding of the products, with full accountability for the end-to-end management of these products throughout the product lifecycle. You wi
Job Source: BarclaysMagnit, Inc.
Newark, NJ, United States
Content Policy Manager (TEMP) Our Client is seeking a Policy Manager to join the content policy team in refining policies and standards that impact their listeners and the creative community with whom we work. This role will work with cross-functional and international teams to align on priorities and deliver solutions to address emerging and ever
Job Source: Magnit, Inc.Empire State
New York, NY, United States
* Applicants MUST submit a cover letter with resume to be considered. *Position expected to work onsite and hybrid consistent with New York State. BASIC FUNCTION: Under the general direction of the Executive Director of the Division of Minority & Women’s Business Development (MWBD), the Policy Manager will work with the Division to developing po
Job Source: Empire StateBrown Brothers Harriman
New York, NY, United States
At BBH we value diverse backgrounds, so if your experience looks a little different from what we've outlined and you think you can bring value to the role, we will still welcome your application! What You Can Expect At BBH: If you join BBH you will find a collaborative environment that enables you to step outside your role to add value wherever y
Job Source: Brown Brothers HarrimanNovartis Group Companies
East Hanover, NJ, United States
Job Description Summary Location: East Hanover, NJ (Hybrid) #LI-Hybrid About the role: Support US corporate reputation through the risk management and shaping of the Novartis story within the US healthcare environment and defined voice within US healthcare policy and issues affecting US patients, healthcare professionals and pharma industry. Job
Job Source: Novartis Group CompaniesBorn in June Creative
, United States
About Born in June Creative Born In June is a Latinx-founded, LA-based- forward-thinking creative and communications consultancy committed to fostering transformation. Our focus lies at the crossroads of innovation and impact, collaborating with like-minded causes and clients dedicated to driving progress. We specialize in developing strategic amp
Job Source: Born in June CreativeLittle Ferry, NJ, United States
It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
The Payment Policy Manager is responsible for managing cross-departmental implementation of changes to payment and billing policies as necessary due to regulatory changes, contractual changes, or as a result of claims data findings. The Payment Policy Manager will collaborate with internal departments to define requirements and to document those requirements sufficiently to ensure accurate implementation of payment rules within the Plan’s adjudication system, including the claim editing system, iCES. The Payment Policy Manager will also review current payment policies and compare them to those used by competitors, state regulatory agencies, and CMS to evaluate and recommend changes, and upon approval incorporate such changes into materials. As directed by the department manager, he/she will project manage regulatory changes that impact payment methods or rates, and help drive analytics to support decision-making.
Our Investment in You:
Full-time remote work
Competitive salaries
Excellent benefits
Key Functions/Responsibilities:
Develops and maintains corporate payment policies, and works collaboratively with the Clinical Editing Manager to ensure consistency with the Plan’s adjudication system(s)
Monitors DHHS, EOHHS, and CMS websites, listservs and other sources to identify existing payment practice and upcoming changes
Determine the scope and impact of the change on Plan operations and seek to implement changes as necessary
Staff and participate in various work groups and committees to support payment policies and provides input into processes and workflows reliant on payment policy outcomes
Serve as the department’s project manager for: (1) regulatory information such as proposed and final Medicare and/or Medicaid payment regulations, Medicare Manual updates, DHHS and EOHHS fee schedules; and (2) regulatory issues
Determine the scope and impact of the information/issues and take appropriate action
Collaborate with Public Partnerships, Contracting, Medical Economics, Provider Relations, Benefit Administration, Business Configuration, and Provider Audit/OPL to determine the impact of implementing recommended policy changes
Develop project plans including: setting timelines and deliverables; determining resource requirements; documents decisions; draft communication plan; information-sharing with appropriate staff and seek approval from the Payment Policy Committee; and subsequently ensure successful completion of change
Serve as the company’s research specialist regarding Medicare and Medicaid payment policies
Serves on the Operational Excellence Committee to ensure a consistent understanding of operational changes as they relate to payment policies and their downstream impact within the Claims department
Submits recommendations to the Payment Policy Committee and supports Committee efforts through subgroups and individually as needed
Collaborate with stakeholder departments to develop and maintain a database to serve a centralized location to store payment methodology information
Research, identify and propose opportunities for medical cost savings, improve claim auto adjudication rate and payment accuracy
Qualifications:
Education:
Bachelor’s Degree in a related field or the equivalent combination of training and experience
AHIMA or other nationally recognized Coding Certification preferred
Education Preferred/Desirable:
Master’s Degree or graduate work in a related field preferred
Coding Certification for Payers (CPC-P) preferred
Experience:
6 or more years’ experience in a fast paced, managed healthcare environment is required
6 or more years direct work in claims processing, payment policy, or contracting
Extensive background of ICD-9 and CPT coding principles
Extensive knowledge of medical claim editing (NCCI, etc.)
Experience working with industry standard methods of payment including DRG, APC, RVU, etc.
Experience working with Medicaid, Medicare and commercial coding rules/ regulatory requirements
Experience Preferred/Desirable:
Medical chart auditing
Competencies, Skills, and Attributes:
Demonstrated proficiency in coding and knowledge of the requirements of industry standards such as Medicare and/or Managed care regulations required
Strong understanding of HIPAA Guidelines
Good communication skills, both oral and written, ability to interact well with others at all levels, strong organizational skills, strong customer service skills and orientation
Expertise utilizing Microsoft Office products, including Project and PowerPoint
Knowledge of OptumInsight iCES product, or similar claims editing system
About WellSense
WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.
Required Skills
Required Experience
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Email Alert for Payment Policy Manager jobs in Little Ferry, NJ, United States
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