2 jobs found in Wyomissing

Claims Payment Policy Lead (Contract) Location: Remote (Must reside in Pennsylvania, New Jersey, or Delaware) About the Role We are seeking a Claims Payment Policy Lead to join our Medical/Health Services team. This role sits at the intersection of clinical expertise and business operations, supporting the development and optimization of claim payment and medical policies .You will play a key role in aligning reimbursement policies with industry standards, identifying cost-saving opportunities, and ensuring policies improve affordability while maintaining quality care outcomes. This is a policy development and strategy role—not a chart audit position. What You’ll Do Lead cross-functional collaboration with clinical, coding, and business teams to design and implement claim payment policies. Develop and maintain reimbursement and medical policies aligned with: Nationally recognized standards (e.g., CMS, Medicare)State and federal regulations Internal benefits, contracting, and...

Job Title: Claims Payment Policy Lead (Clinical + Coding) Location: Remote (Must reside in PA, NJ, or DE) About the Role We are seeking a Claims Payment Policy Lead to support a dynamic Medical/Claims Policy team. This role sits at the intersection of clinical expertise and healthcare coding/billing, focusing on policy development (not audits) to drive cost efficiency and align with industry standards. Key Responsibilities Lead policy-driven initiatives to identify and implement medical cost-saving opportunities Develop and maintain claim payment and medical policies aligned with: CMS/Medicare guidelines, Industry reimbursement practices, State & federal regulations Monitor industry trends and regulatory changes Analyze utilization patterns and claims data to recommend improvements Develop business cases and policy documentation. Serve as a clinical and/or coding SME and mentor team members Ensure accurate coding alignment (CPT, HCPCS, ICD guidelines) Required...