Medical Policy Director
New
Fully remote work environment within the continental United States.Full-TimeDirector
Salary120,000 - 145,000 USD per year
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Job Details
- Experience
- 7–10 years
- Required Skills
- Data AnalysisPresentation skills
Requirements
- Bachelor’s degree in a relevant field or equivalent experience.
- Professional coding certification required (CPC, CPC-A, CCA, CCS, or CCS-P); RHIT or RHIA preferred.
- 7–10 years of relevant experience in healthcare, client services, or related fields.
- At least 5 years of experience in claims adjudication, medical policy editing, or reimbursement policy using Medicare/Medicaid and coding standards (ICD, CPT, HCPCS).
- Health plan, managed care, or insurance industry experience preferred.
- Strong presentation skills with the ability to influence and communicate across technical and executive audiences.
- Excellent analytical and problem-solving skills with the ability to interpret complex datasets.
- Strong organizational skills with the ability to manage multiple priorities in a fast-paced environment.
- Proficiency in Microsoft Office tools, including Word, Excel, PowerPoint, and Outlook.
- Ability to work independently in a remote environment with limited supervision.
Responsibilities
- Act as a subject matter expert for medical policy, coding standards, and payment integrity rules within a comprehensive policy library.
- Analyze client data to identify opportunities for new or improved medical policies, including validation of financial and operational impact.
- Select and prepare real claim examples to support policy presentations and client understanding.
- Develop presentation materials and supporting documentation for internal committees and external client meetings.
- Lead and deliver policy presentations, clearly articulating rationale, data insights, and expected impact.
- Collaborate with clinical leaders and client stakeholders to validate edits and support adoption of new policies.
- Participate in client engagements as a trusted advisor and ensure timely follow-up on deliverables and action items.
- Identify opportunities to expand solution adoption and strengthen client value through policy optimization.
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