Medical Standards Research Coordinator
Medical Standards Research Coordinator
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Salary Not Disclosed
1 Vacancy
Job Description
Overview
Now hiring a Medical Standards Research Coordinator
Responsible for the research analysis planning implementation evaluation and development of PHP Medical policies clinical criteria and technology assessment processes that promulgate PHP/PIC medical coverage policies and benefit determination guidelines
How you belong matters here.
We value our employees differences and find strength in the diversity of our team and community.
At Presbyterian its not just what we do that matters. Its how we do it and it starts with our incredible team. From Information Technology to Food Services and beyond our nonclinical employees make a meaningful impact on the healthcare provided to our patients and members.
Why Join Us
- Full Time Exempt: Yes
- Job is based at Rev Hugh Cooper Admin Center
- Remote work from home: this job is intended to be conducting in the state of New Mexico.
- Work hours: Days
- Benefits: We offer a wide range of benefits including medical wellness program vision dental paid time off retirement and more for FT employees.
Ideal Candidate: Bachelors in related field. Experience in coding researching medical coverage and policy development. Three to five years experience in CMS Coverage guidelines research and general medical literature
Qualifications
- Licensed RN or other Health Care Professional with experience in coding researching medical coverage and policy development.
- Bachelors in related field or two to three years college level courses.
- Three to five years experience in CMS Coverage guidelines research and general medical literature.
- Excellent written and verbal communication skills.
- Detail and results oriented. Experience with CPT ICD9CM HCPCS Level II coding rules and regulations Medicare AMA and industry standards is a plus.
- Candidates must possess strong organizational research and writing skills and a high level of energy as well as a strong commitment to excellence.
- The ability to demonstrate critical thinking and ethical behaviors is required.
- Must be highly selfmotivated and have demonstrated ability to perform clinical research summarize study results review and summarize literature which describes evidencebased conclusions and industry practices.
- Must be very comfortable with PCoffice tools.
Education:
Essential:
* Associate Degree
Responsibilities
- Develops medical policy (e.g. cancer treatment transplants) and benefits (e.g. durable medical equipment ambulance services)
- Scans the available literature for emerging technologies and/or new uses for existing technologies
- Researches recent peerreviewed clinical literature CMS guidelines related public domain literature and PHP/PIC licensed sources such as Milliman and recommendations from research for presentation to related PHP/PIC clinical quality committees (such as TAC MPC CQC) Develops organizes and maintains coverage documents for electronic and hardcopy records.
- Scans medical literature for emerging technologies.
- Reviews benefits/services related financial impact and potential coverage changes by managing the cross departmental Medical Policy Committee (MPC)
- Maintains the online Medical Policy Manual and ensures completeness accuracy and ease of use
- Researches and resolves benefit related questions for internal staff which includes heading adhoc work groups and conducting special sessions for coverage issues requiring immediate attention. Develops and carries out project plan for oversight of delegated operational functions.
- Monitors and maintains compliance with state federal NCQA and contractual requirements relating to benefits and coverage issues.
- Maintains relationships with PHP/PIC commercial Medicaid and Medicare compliance officer in relation to benefits and benefit related documents.
- In collaboration with Product Development implements benefit changes both standard and nonstandard via the above mentioned committees.
- Regularly reviews new HCPCS and CPT codes via the Health Services Coding/Medical Record team lead configuration and finance as necessary.
Benefits
All benefitseligible Presbyterian employees receive a comprehensive benefits package that includes medical dental vision shortterm and longterm disability group term life insurance and other optional voluntary benefits.
Wellness
Presbyterians Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your wellbeing. Earn gift cards and more by taking an active role in our personal wellbeing by participating in wellness activities like wellness challenges webinar preventive screening and more.
Why work at Presbyterian
As an organization we are committed to improving the health of our communities. From hosting growers markets to partnering with local communities Presbyterian is taking active steps to improve the health of New Mexicans.
About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients members and the communities we serve. We are locally owned notforprofit healthcare system of nine hospitals a statewide health plan and a growing multispecialty medical group. Founded in New Mexico in 1908 we are the states largest private employer with nearly 14000 employees including more than 1600 providers and nearly 4700 nurses.
Our health plan serves more than 580000 members statewide and offers Medicare Advantage Medicaid (Centennial Care) and Commercial health plans.
AA/EOE/VET/DISABLED. PHS is a drugfree and tobaccofree employer with smoke free campuses.
Maximum Offer for this position is up to
Compensation Disclaimer
Required Experience:
IC
Employment Type
Full-Time
