The candidate will be a member of the Lab Management Program and will be responsible for designing, implementing, and monitoring a claims processing product that remains in alignment with rapidly shifting commercial, Medicare, and Medicaid medical policy. This requires a working knowledge of procedure coding, diagnosis coding, claims data elements, and claims system capabilities. Experience in a clinical laboratory setting is critical with at least five years’ experience. Major responsibilities include: Work with medical policy team to understand the policy goals and ensure appropriate associated coding and claims processing language; work with analytics to model policy-based claims processing to ensure the expected outcomes in historical claims data; Coordinate claims configuration design, implementation, maintenance, customization, and documentation; Act as subject matter expert for claims disputes; Monitor claims product performance, including accurate processing, value metrics, trends, unusual billing patterns, and opportunities for enhancement; and Manage projects to continuously improve the claims processing product.
