Medical Policy Specialist

Under the direction of the Medical Policy Supervisor and indirect supervision of the Medical Policy Coordinator, the Medical Policy Specialist will be responsible for establishing and maintaining accurate, formal two-way communication with internal staff, BCBSKS contracting providers, and Board members regarding all medical policy related matters. The Medical Policy Specialist is responsible for managing all meetings, documentation, governance and activities related to medical policy.

“This position is eligible to work onsite or hybrid (9 or more days a month on site) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.”

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Why Join Us

• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.

• Family Comes First: Total rewards package that promotes the idea of family first for all employees.

• Professional Growth Opportunities: Advance your career with ongoing training and development programs.

• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.

• Flexibility: options to work onsite or hybrid available

• Balance: paid vacation and sick leave with paid maternity and paternity available immediately upon hire

Compensation

$23.00 - $27.30 hourly
Non-Exempt 12

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid.  All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.
   

What you’ll do

• First point of contact and primary liaison for medical policy, dealing with correspondence, inquiries and concerns from providers, internal personnel, and group representatives related to liaison committees, contracting, claims, reimbursement, and medical policies, ensuring effective communication and collaboration.

• Oversees the creation, distribution, and ongoing maintenance of documentation, including researching meeting materials, developing agendas, and composing, editing, and distributing meeting minutes, reports, project plans, and correspondence—while ensuring accuracy and proper recordkeeping within the Medical Policy Access Database.

• Responsible for ensuring medical policy updates remain on scheduled reviews timetable.

• Responsible for final editing and formatting, review of medical policies and updating codes and nomenclatures as needed between updates.

• Timely and accurately reviews and submits medical policies through Workfront for posting and notify appropriate internal and external stakeholders of updated policy postings.

• Maintains tracking of utilization on medical policies.

• Troubleshoots medical policies at implementation to identify and correct potential errors, which may result in improper claims payment or misinformation to internal or external stakeholders. 

• Assist with Liaison Committee provider inquiries and policy development which includes but not limited to explanation of record specifications, medical policy criteria, guidelines and coding.

• Formats pharmacy policies submitted by pharmacy partners, including Prime and/or Magellan.

• Collaborates with health analytics to request metrics, including codes to be utilized, and reports on various topics at the request of the Medical Policy coordinator

• Independently responsible of dual coordination of virtual platforms and onsite meetings with video conferences and provide necessary IT support to attendees during the Liaison and Medical Advisory Committee Meetings, many of which occur outside standard business hours.

• Must provide timely, accurate and professional follow-up with contracting providers who are liaison committee members with concerns in general with Blue Cross and Blue Shield of Kansas to include medical policies, contracting status, claims, or reimbursement.

• Research and maintain records on contracting providers to be eligible for the liaison committee which requires coordination with SIU, Provider Network Solutions and Medical Analytics.

• Coordinates travel arrangements, expense reports, p