Summary of Responsibilities:
The Medical Policy Analyst is responsible for the research, analysis, development, maintenance, coordination, and documentation of medical policy for all lines of business for Highmark and its affiliated companies that utilize Highmark Medical Policy. This includes the development and maintenance of policy for Highmark's Medicare Advantage products. The incumbent is accountable for coordinating and assuring that the appropriate OSCAR system changes are implemented in concert with policy changes. This position also responds to medical policy-related inquiries and Medical Director requests for evaluation of new technologies and/or new uses of existing technology that may or may not result in medical policy update activity. This position also works directly with the Professional Consultant Network that is comprised of approximately 250 professional providers that represent all professional specialties recognized by Highmark. This position requires the ability to multi-task, and be able to adapt to an ever changing environment. The incumbent must possess excellent writing, communication, and analytical skills, be flexible, as well as possess the ability to work independently. Both medical and operational backgrounds are preferred in addition to proficient computer skills.
Highmark is an Affirmative Action/Equal Employment Opportunity (AA/EEO) employer.
* A Bachelors degree.
* One (1) to three (3) years of experience in Claims Operations, Provider Relations, Product Management or Medical and Payment Policy Administration.
* A comprehensive knowledge of all the medical/surgical products administered by Highmark. This includes products administered under the Medicare Advantage program.
* This position requires analysis of CMS documents such as transmittals and the Federal Register.
* Excellent communication skills are a must because of the interaction with various internal departments, as well as communications with physicians, state specialty societies, etc.
* This position also requires a technical background in the application of Highmark's processing system.
* Well developed computer skills are a must to perform the research that this job requires.
* A clinical/medical background is a given attribute in performing the various levels of decision making required.
* Independent assessment and excellent time management skills are necessary components of this multi-tasking job accountability.
* An RN license or LPN certification
Highmark has staked its claim as the largest health insurer in the Keystone state. A licensee of the Blue Cross and Blue Shield Association,...