Medical Standards Research Coordinator

Presbyterian Healthcare Services; Albuquerque (NM); Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a Medical Standards Research Coordinator to enhance healthcare policies and practices. This role involves researching and analyzing medical coverage, developing policies, and working closely with various committees to ensure compliance and efficiency. The ideal candidate will have a strong background in medical research, excellent communication skills, and a commitment to improving patient care. Join a dynamic team dedicated to making a meaningful impact on healthcare delivery in New Mexico, while enjoying a comprehensive benefits package and a supportive work environment.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

Paid Time Off

Retirement Plan

Wellness Program

Employee Wellness Rewards

Short-term and Long-term Disability

Life Insurance

Flexible Work Hours

Qualifications

• Licensed RN or Health Care Professional with coding experience.
• Three to five years in CMS Coverage guidelines research.

Responsibilities

• Develops medical policies and benefits for various treatments.
• Researches clinical literature and CMS guidelines.
• Maintains compliance with state and federal regulations.

Skills

Research Skills

Analytical Skills

Communication Skills

Coding

Detail-oriented

Education

Bachelor's Degree in Related Field

Associate Degree

Tools

PC Office Tools

Job description

Medical Standards Research Coordinator

Requisition ID

2025-47237

Category

Education/Informatics/Research

Location : Name

Rev Hugh Cooper Admin Center

Location : City

Albuquerque

Location : State/Province

NM

Minimum Offer

USD $31.32/Hr.

Maximum Offer for this position is up to

USD $47.83/Hr.

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, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical 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, ICD-9-CM, 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 self-motivated and have demonstrated ability to perform clinical research, summarize study results, review and summarize literature which describes evidence-based conclusions and industry practices.
• Must be very comfortable with PC-office 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 peer-reviewed clinical literature, CMS guidelines, related public domain literature, and PHP/PIC licensed sources such as Milliman and Hayes.Generates 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 hard-copy 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 on-line Medical Policy Manual and ensures completeness, accuracy and ease of use
• Researches and resolves benefit related questions for internal staff, which includes heading ad-hoc 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 non-standard 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 benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being 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, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

Maximum Offer for this position is up to

USD $47.83/Hr.

Compensation Disclaimer

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.

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