The candidate will be a member of the Lab Management Program and will become a subject matter expert on Government Program policies relevant to the Lab Program’s scope of services. Major responsibilities include:
Identifying and documenting all relevant coverage materials, such as manuals, fee schedules, policies, regulations, etc. necessary to align with eviCore policies and processes.
Working with the medical policy team to establish the heirachy of which policies apply to ensure compliance with Federal, State and Health Plan direction.
Designing customized clinical pathways for tests requiring prior authorization for Government Programs.
Developing and maintaining requirements for claim processing rules in alignment with Government Program direction.
Performing surveillance and tracking of Government Program policies to ensure our systems and processes remain current at all times.
Supporting related prior authorization and claim denial disputes.
Performing additional duties as roles and the business evolve.
Minimum Experience Required
Bachelor's degree or equivalent work experience.
5+ years’ experience in healthcare or related field.
Experience with Medicare and/or Medicaid claims processing or policy development strongly desired.
Knowledge of laboratory medicine is preferred.
Analytical, problem-solving nature with ability to work with data and reporting tools to research, organize, and summarize findings.
Detail-oriented with the strong organizational skills required to accurately track thousands of claims policies and updates.
Working knowledge of procedure coding, diagnosis coding, claims data elements, and claims system capabilities.
Self-motivated with ability to define projects, prioritize responsibilities in a fluid environment, and work with minimal instruction or supervision.
Excellent verbal and written communication skills as well as the ability to effectively interact with all levels of staff and management.
Strong organizational skills.
Our Company and What We Offer
eviCore healthcare is committed to making a positive impact on healthcare, and also making a positive impact on our employees. eviCore offers a variety of perks and benefits including, but not limited to:
Flexible scheduling and work/life balance with remote and work from home opportunities
3 weeks of PTO(starting) per year plus paid holidays
Education assistance, tuition reimbursement and professional certifications
Health, dental, vision, and life benefits with employer funded HSA
Comprehensive employee discount program, onsite fitness facilities, and smart casual dress code
Paid Volunteer Community Service Days
Ample opportunities for growth, advancement, and promotion
401k retirement plan with company match of 50% employee contributions up to 6%