Senior Health Policy & Benefits Lead - Remote

Intermountain Healthcare Inc.; Hagåtña (GU); Remote; USD 43,000 - 67,000; Full time

Job summary

Intermountain Health in Murray, Utah, seeks a Policy Director to lead development and implementation of health plan policies, adjudication rules, and provider reimbursement schedules. You will bridge policy concepts with operational practice and coordinate cross-functional teams to ensure compliant, effective benefits.

Ideal candidates have extensive policy experience in healthcare or insurance, strong project management skills, and excellent communication.

Qualifications

• Four years of policy experience.
• Two years of experience in a medical benefits or insurance setting, or other related work experience to gain a good understanding of claims and eligibility issues, basic medical coding expertise, and insurance product knowledge.
• Experience managing projects that require strong interpersonal and organizational skills and the ability to perform under stress and to meet deadlines.
• Excellent oral, written, and interpersonal communication skills.
• Intermediate skills in computer-based word processing and spreadsheets.

Responsibilities

• Leads the development and implementation of health plans policies, which are used to develop adjudication rules, define coverage for benefits, program the claims payment system and develop provider reimbursement schedules.
• Leads the implementation process which affects or are affected by the policies. Bridges the gap between broad policy and product concepts and operational practice throughout Select Health.
• Oversees the research process which includes initial request for policy development or modification through analysis and development of recommended policy to senior management, and implementation of approved policy.
• Develops policies. Considers the fit with organizational goals and strategies, impact on organization's initiatives, long-term marketing strategies, and the amount of clinical input required to determine if the request fits the scope policy process.
• Presents recommendations, answers questions about the analysis as well as impacts and ease of implementation. Presents issues and recommendations based on findings.
• Oversees the implementation of approved policy/product changes and coordinates the efforts of an implementation team with affected management and their functional areas of responsibility.
• Provides support and acts as a resource for projects or teams needing extensive input from a policy specialist.
• Stays current on changes, practices, policies, and all aspects of the business to provide accurate information about benefit quoting and proper adjudication. Learns about policies and procedures associated with each functional area.
• Oversees the coding review process, makes coverage and benefit determinations on each individual code. Implements coding determination changes through documentation, system set up and, if necessary, provider communication.
• Champions and leads initiative for policies requiring change.
• Participates in functional area committees to ensure consistent policy development.
• Assists in other product development activities and projects, such as benefit design research, member satisfaction research and market research, as well as project tracking, prioritization, and other related project management activities.

Skills

Health Care Regulation

Communication

Project Management

Decision Making

Attention to Detail

Analytical Thinking

People Management

Cultivates Necessary Relationships

Initiative

Accountability

Education

Bachelor's Degree in business or healthcare related field

Job description

Intermountain Health in Murray, Utah, seeks a Policy Director to lead development and implementation of health plan policies, adjudication rules, and provider reimbursement schedules. You will bridge policy concepts with operational practice and coordinate cross-functional teams to ensure compliant, effective benefits.

Ideal candidates have extensive policy experience in healthcare or insurance, strong project management skills, and excellent communication.