Policy and Publication Specialist

About the Policy and Publication Specialist:

The Policy and Publication Specialist team member is part of the Policy Operations and Enforcement Team reporting directly to the Policy and Publication Manager. The Policy and Publication Specialist is responsible for managing the distribution and publication of medical policies, including formatting, editing, and ensuring accuracy and clarity of information by collaborating with internal stakeholders to align Policy Operations and Enforcement updates with client medical policy requirements.

This position is eligible for remote work, but quarterly travel will be required to the corporate office located in Tampa, Florida.

Policy and Publication Specialist - Essential Functions and Responsibilities:

• Collaborate with internal stakeholders supporting quarterly medical policy maintenance activities.

• Edit and proofread revised client medical policies to ensure accuracy and consistency of prior/current client policy language/decisions.

• Communicate medical policy updates clearly to clients and respond to inquiries regarding medical policy interpretation and implementation.

• Manage the publication process, including uploading content to online platforms.

• Collaborate with cross-functional teams to align client decisions with coding, translation, and configurational requirements.

• Collaborate with other departments to proactively seek client medical policy decisions.

• Collaborate with the Implementation Team by facilitating medical policy reconciliation meetings with new clients. Traveling to client location required.

• Remote workers are required to travel to the Tampa office for quarterly in-person meetings when scheduled.

• Engagement in the creation and transition of IT ticketing system to support transitioning workflow.

• Maintain and update data resources to ensure accurate and reliable reporting.

Policy and Publication Specialist - Qualifications:

• 13 years relevant work experience

• Bachelors Degree or equivalent work experience

• Experience creating/revising policies, standard operating procedures, and/or guidelines within a managed care organization or similar healthcare environment

• Understanding and experience working with CPT codes and diagnosis codes

• Understanding of process improvement principles

• Outstanding written and verbal communication skills

• Proficient computer skills (Excel, Word, PowerPoint, Jira, PDF creation)

• Strong organizational skills and ability to prioritize and manage multiple projects

• Flexible and ability to learn new technologies

• Ability to interact effectively with counterparts and assigned clients

• Ability to interpret and synthesize complex healthcare literature and clinical information

Policy and Publication Specialist Preferred Qualifications:

• Previous health plan experience desired

• Experience with medical terminology (CPT code and diagnosis codes)

• Previous experience working in a start-up or early-stage company is helpful