Insurance Clinical Guideline Manager Job at USA Clinics Group
USA Clinics Group is looking for an Insurance Clinical Guideline (ICG) Manager to join our team at our Northbrook Corporate Office! USA Clinics Group is a multistate, multispecialty, care provider with over 200 clinics across the nation. The successful candidate will thrive in a high energy, tech savvy, multitasking environment. The IGC Manager will collaborate with physicians, SVP of Revenue Cycle, and other members of the management team. They will serve as a critical link between providers, payers, our HIM Team.
Primary Responsibilities:
- ICG Manager will manage the organizations adherence to all appropriate payer clinical and frequency guidelines
- Maintain and improve the guideline tracking and usage system ensuring patients care plans are referencing the lates Insurance requirements.
- Work with the IT development team on automated payer guidelines validation
- Educate clinical care team on the latest payer requirements
- Provide real time assistance to physicians when developing patient treatment plans
- Assist revenue cycle team with insurance company appeal templates for medical necessity guidelines
Requirements
- High school diploma or equivalent required.
- Bachelor’s degree preferred.
- 5+ years of experience working with Insurance company guidelines
Benefits
- 401(k) matching
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
- IND1
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