Medical Policy Admin Coord

Medical Policy Admin Coord

Requirements

• High School Diploma/GED required.
• Bachelor degree preferred or relevant experience in lieu of degree.
• Minimum of five (5) years of work experience in the healthcare industry.
• Proficiency in using personal computers, Microsoft Office Suite (Word, Excel, PowerPoint) and of intranet/internet applications such Outlook, SharePoint, Webex.
• 3-4 years experienced in healthcare setting.

Responsibilities

• Manage the review and update of committee charters in collaboration with leadership. Monitor committee compliance with charters and procedures. Work with the chairperson to address gaps.
• Oversee data integrity in committee databases and document repositories.
• Organize and file committee meetings materials, per regulatory and Horizon Guidelines for audit readiness. Develop and maintain detailed documentation on committee processes, workflow, and procedure for the medical policy end to end process playbook.
• Schedule meetings, create, manage, and submit agenda including meeting material prior to the meeting, track follow-up items, and upload documents to SharePoint.
• Take detailed meeting minutes, with complex medical and technical information, at meetings, distribute them, maintain issue log, and ensure follow-up on action items and issues until completion or resolution.
• Create meeting presentations that include clinical, coding and integration content and incorporate input from multiple sources. Ensure timeliness and flawless execution.
• Manage multiple priorities and interface with senior leaders within Horizon regarding the team’s priorities. Interface outside of horizon coordinating peer to peer discussions as well as reviews of the appeals processes. Proactively resolve gaps in workflows, deliverables and inquiries and keep stakeholders informed.
• Provide general administrative support reviewing and responding to incoming and outgoing correspondence regarding specific Medicaid inquiries such as continuation of enrollment reviews.
• Coordinate communication and material submission with multiple Independent Medical Expert (IME) vendors (MES, MCMC).
• Coordinate new employees on-boarding including education sessions, monitoring HR requirement, coordinating equipment and access to relevant applications. In addition, oversees use of hardware, office supplies and applications access to the department employees.
• Manage ACM access to the EMM (evidence management Module) based on security permissions.
• Manage departmental contingent workers recruitment, maintenance facing sourcing and invoice management and payments. Manage departmental administrative budget and expense accounts including invoices for multiple vendors and maintenance of organizational memberships. Manages and provides Forecasts for departmental assigned cost centers.
• Prepare presentations and FAQ’s supporting documentation internal/external audits.
• Coordinate and monitor the medical director’s transactional volume for appeals, appeals committees, and escalations.
• Coordinate medical directors’ quality week including assignments to member appeals committees and internal peer reviews.
• Analyze data, identify trends and compile reports. Run recurrent and ad Hoc SAS reports to provide utilization data for specific medical policies. Prepare reports based on committee findings. Manage Tableau dashboard updates to support the utilization analysis for medical policy development, maintenance, and executive summaries.
• Perform other duties as needed.

Preferred Qualifications

• General knowledge and/or familiarity with medical terminology (preferred).
• Effective presentation skills and ability to answer questions from groups (preferred).