Remote NP: Clinical Policy & Government Programs Lead

Impresiv Health, LLC.; Tampa (FL); A distancia; USD 110.000 - 160.000; Jornada completa

Descripción de la vacante

Impresiv Health is recruiting an experienced Clinical Policy & Government Programs Specialist to support Medicare and Medicaid policy alignment, claims-edit validation, and regulatory compliance. The NP background with coding expertise will translate complex regulations into actionable operational workflows and collaborate with Clinical, Operations, Legal, and Technology teams.

The role emphasizes interpreting NCDs/LCDs, validating CPT/HCPCS rules, and monitoring regulatory updates, with

Formación

• Bachelor's degree in Nursing (BSN) and/or MSN.
• 7+ years of relevant professional experience.
• 3+ years in claims editing, payment integrity, coding/auditing, or health plan operations.
• Professional coding certification (CPC, CCS, CPC-P) or equivalent.

Responsabilidades

• Review and interpret NCDs, LCDs, and MAC requirements.
• Validate claims-edit configurations against Medicare requirements.
• Verify CPT/HCPCS code exclusions and coverage rules.
• Review monthly regulatory updates and identify required configuration changes.
• Document validation results, elevate discrepancies, and monitor resolution.
• Conduct policy reviews to identify changes from updated Medicare/Medicaid requirements.
• Prepare regulatory change summaries and code-level impact assessments.
• Support policy reconciliation and implementation activities.
• Maintain documentation of policy changes and enforcement requirements.
• Research state Medicaid requirements, coverage mandates, and applicable legislation.
• Translate legislative/regulatory changes into actionable recommendations.
• Serve as SME for Medicare, Medicaid, and clinical policy requirements.
• Collaborate with clinical leadership, legal teams, and operations.
• Support client implementations, policy discussions, and regulatory presentations.
• Evaluate state mandate requests and recommend policy or operational considerations.
• Develop and maintain SOPs, documentation, and regulatory controls.
• Identify opportunities to improve policy monitoring, validation, and reporting processes.
• Explore automation and AI-assisted tools to improve regulatory research and analysis.
• Collaborate across departments to strengthen compliance and operational consistency.

Conocimientos

Regulatory knowledge

Analytical skills

Attention to detail

Documentation

Cross-functional collaboration

Excel proficiency

Communication

Educación

Bachelor's degree in Nursing (BSN)

Master of Science in Nursing (MSN)

Herramientas

JIRA

SharePoint

SQL

Descripción del empleo

Impresiv Health is recruiting an experienced Clinical Policy & Government Programs Specialist to support Medicare and Medicaid policy alignment, claims-edit validation, and regulatory compliance. The NP background with coding expertise will translate complex regulations into actionable operational workflows and collaborate with Clinical, Operations, Legal, and Technology teams.

The role emphasizes interpreting NCDs/LCDs, validating CPT/HCPCS rules, and monitoring regulatory updates, with