Ensures compliance with healthcare regulations and policies for state Medicaid and Duals line of business as it related to payment policies
Support the operational processes of the Medicaid Health Policy Governance
Monitor status reports to ensure effective workflow and timely development of coding and payment policies
Support internal departments and processes in the development and implementation of policies and procedures
Ensure all medical policies are compliant with relevant regulations and are consistent across all lines of business
Participate in department initiatives, scorable action items, and projects
Work with health plan business leaders and corporate leaders to develop deliverables on policy priorities
Provide medical coding and payment policies deliverables for Medicaid and Duals and other markets as business needs change
Work with business product owners, government relations, and compliance leads to monitor legislative and regulatory activities for potential impact on existing or proposed policies
Collaborate with interdisciplinary team members to achieve team goals
Perform any other job duties as requested

5 years relevant work experience
3 years of healthcare-related writing experience
Experience in writing payment policies for state specific Medicaid policy, Medicare policy writing a plus
3 years of experience in medical policy development and/or implementation
Coding and managed care background
Effective communication skills, both verbal and written
Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
Proficiency with computer skills which includes navigating multiple systems and keyboarding
Strong presentation skills
Ability to travel up to 10% for meetings as needed
Bachelor's degree preferred/specialized training/relevant professional qualification – or equivalent experience

Medicaid Payment Policy Writer – Code Editing Manager

Key skills