Medical Policy Specialist II

Medical Policy Specialist II develops and maintains Horizon Blue Cross Blue Shield of New Jersey medical policy in conjunction with physician staff. Responsibilities include gathering and analyzing data, monitoring CMS directives, and presenting policies to the Clinical Policy Committee. The role requires in-depth knowledge of anatomy and physiology, health care delivery systems, and medical coding structure.

Requirements

• High School Diploma/GED required
• Bachelor degree preferred or relevant experience in lieu of degree
• Five to seven years clinical nursing/physician experience
• Three to five years medical claims processing experience
• Clinical research and policy development and maintenance experience
• Data management (gathering and analysis) experience

Benefits

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous Paid Time Off
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement