Medical Policy Support Specialist

State of Utah

Full Job Description
Job Description
The Medical Policy Team in the Bureau of Healthcare Policy & Authorization (BHPA) is responsible for developing and overseeing medical coverage policies for Medicaid members. The purpose of this position is to develop and maintain quality control measures, manage various Medicaid Committees, and support the Medical Policy Team in coverage policy development.

The position works as part of a team, providing detailed medical program expertise and collaborating with other team members to manage core team functions.

The ideal candidate hired for this position will have:

Understanding and experience working with CPT, HCPCS, ICD-10-CM, and ICD-10-PCS coding and reporting regulations.
Familiarity with Division of Medicaid and Health Financing (DMHF) systems including MMCS and MMIS.
Committee management experience.
Robust critical thinking demonstrated through observation, analysis, inference, communication, and problem-solving skills.
Strong and well developed technical writing skills.
Experience with healthcare policy, particularly government programs.

Candidates must have the following:
Two years of healthcare-related experience.
Two years experience with MMCS and MMIS.
Relevant experience with committee management.

Why work for the Utah Department of Health? In addition to the rich benefits the State of Utah offers, the department offers:
On-site fitness center, for a minimal membership fee
UTA Eco Pass, at a discounted monthly rate
Teleworking opportunities
On-site day care center with First Steps Day Care – contact for rates and availability, 801-538-6996

For more information on the Utah Department of Health, please click HERE.

If offered this position, your employment will be contingent upon passing a background check and review. There will be no cost to you for this check. This check will include fingerprinting, which will be available at various UDOH locations for your convenience. Fingerprinting will be completed prior to your first day of employment. You may review the policy by clicking HERE. (Download PDF reader)


Example of Duties

Consult on policy recommendations aligning with correct coding regulations and policy.
Review and respond to stakeholder coverage policy related inquires
Develop and maintain quality improvement measures
Design appropriate code coverage of services while ensuring compliance with applicable federal and state laws.
Management of various DMHF committees.
Plan and allocate resources to ensure agency implementation of policies and state statutes.


Supplemental Information

Risks found in the typical office setting, which is adequately lighted, heated and ventilated, e.g., safe use of office equipment, avoiding trips and falls, observing fire regulations, etc.
Typically, the employee may sit comfortably to perform the work; however, there may be some walking; standing; bending; carrying light items; driving an automobile, etc. Special physical demands are not required to perform the work.

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