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Experian is a global data and technology company, powering opportunities for people and businesses around the world. We help to redefine lending practices, uncover and prevent fraud, simplify healthcare, create marketing solutions, and gain deeper insights into the automotive market, all using our unique combination of data, analytics and software. We also assist millions of people to realise their financial goals and help them save time and money.
We operate across a range of markets, from financial services to healthcare, automotive, agribusiness, insurance, and many more industry segments.
We invest in people and new advanced technologies to unlock the power of data. As a FTSE 100 Index company listed on the London Stock Exchange (EXPN), we have a team of 22,500 people across 32 countries. Our corporate headquarters are in Dublin, Ireland. Learn more at experianplc.com
At Experian Health, our employees have the opportunity to shape more than products – they shape the future of U.S. healthcare. Experian Health is a pioneer for innovations leading the way in revenue cycle management, identity management, patient engagement, and care management for hospitals, physician groups, labs, pharmacies and other risk-bearing entities.
The Managed Care Policy Manager will lead a team responsible for creating written communications created in the Payer Alerts application to inform physicians, clinics, hospitals, and other healthcare organizations about changes in payer policies and procedures. The manager will ensure tasks are prioritized and completed effectively.
Key Responsibilities:
Plan, staff, review, and organize team assignments.
Provide leadership, coaching, guidance, training, and staff development.
Oversee staff salary planning, personnel actions, and performance management processes.
Set production goals and monitor progress.
Maintain and distribute team statistics.
Manage subscriber issues and requests for new payers.
Oversee the newsletters log, ensuring all outstanding newsletters are addressed.
Assist with auditing analysts and retraining as necessary to maintain a quality rating of 95% or higher.
Regularly review assignments for payers in Web Watchers to ensure balanced workloads.
Answer questions from Managed Care Analysts on topics including:
Drug, condition, and disease identification.
Classification of information into Administrative, Clinical, Pharmaceutical, and Reimbursement categories.
Creation of concise summaries of updated medical information.
Identifying alert-worthy information for clients.
Issues that may arise in the Website Watcher application.
Qualifications:
Education:
Bachelor's degree or equivalent experience.
Knowledge of medical terminology is an advantage.
Experience:
Minimum of ten years in the healthcare industry.
Preferred experience in billing or claims.
Experience with a Medicare contractor agency is highly desirable.
Knowledge:
Familiarity with various coding conventions such as ICD-10, CPT, and HCPCS codes.
Understanding of different health insurance payers, including:
Commercial Plans
Medicare
Medicare Advantage Plans
Medicaid
Medicaid Managed Care Organizations
Broad knowledge of medical specialties, physicians, non-physician providers, and facility vs. non-facility providers.
Ability to match medical conditions to the correct specialties.
Preferred knowledge of medical terminology.
Benefits/Perks:
Great compensation package and bonus plan
Core benefits including full medical, dental, vision, and matching 401K
Flexible work environment, ability to work remote, hybrid or in-office
Flexible time off including volunteer time off, vacation, sick and 12-paid holidays
Our uniqueness is that we celebrate yours. Experian's culture and people are important differentiators. We take our people agenda very seriously and focus on what matters; DEI, work/life balance, development, authenticity, engagement, collaboration, wellness, reward & recognition, volunteering... the list goes on. Experian's people first approach is award-winning; Great Place To Work™ in 24 countries, FORTUNE Best Companies to work and Glassdoor Best Places to Work (globally 4.4 Stars) to name a few. Check out Experian Life on social or our Careers Site to understand why.
Experian is proud to be an Equal Opportunity and Affirmative Action employer. Innovation is an important part of Experian's DNA and practices, and our diverse workforce drives our success. Everyone can succeed at Experian and bring their whole self to work, irrespective of their gender, ethnicity, religion, colour, sexuality, physical ability or age. If you have a disability or special need that requires accommodation, please let us know at the earliest opportunity.
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