Senior Health Policy & Implementation Lead

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

Job summary

Intermountain Health is seeking a Senior Policy Specialist to lead the development and implementation of health plans policies, bridging policy concepts with operational practice across Select Health. You will oversee policy research, coding reviews, and cross-functional implementation teams to ensure accurate adjudication and benefit design decisions.

The role requires deep knowledge of claims adjudication, healthcare regulations, and strong 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 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 a business or healthcare related field

Job description

Intermountain Health is seeking a Senior Policy Specialist to lead the development and implementation of health plans policies, bridging policy concepts with operational practice across Select Health. You will oversee policy research, coding reviews, and cross-functional implementation teams to ensure accurate adjudication and benefit design decisions.

The role requires deep knowledge of claims adjudication, healthcare regulations, and strong communication.