Position Title: Policy and Procedure Specialist
Requisition #: 24941
Department: Claims
Title of Manager: Director, Operations
Supervises: Non-Supervisory position
Employment Status: Non-Exempt
Pay and Benefits: Estimated hiring range $27.67-$33.83/hr., 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits
Posting Notes This is a fully remote role, but you must reside in one of the listed 9 states.
Job Summary
The Policy and Procedure Specialist is responsible for developing, implementing, and maintaining infrastructure to support policies and procedures for Operations departments such as Claims, Payment Integrity, Enrollment and Clinical Operations. Core areas of focus include coordination of policies and procedures, documentation reviews, and proactive monitoring. This position is also responsible for maintaining awareness of potential regulatory or other changes that could impact internal oversight activities.
Essential Responsibilities
- Track and communicate changes to regulatory requirements and work with operational managers to update documentation.
- Lead, guide and manage the operations document committees to meet goals and objectives.
- Make recommendations for creation of, or improvement upon, policies and procedures to improve oversight for high quality care and compliance with contractual and regulatory requirements from multiple sources.
- Manage all aspects of the documentation process, including planning, content maintenance, timely annual reviews, and publishing.
- Receives and reviews requests to create new policies and procedures; analyzes proposed policies to determine if they are a policy, procedure, or other deliverable type and directs policy owners through the appropriate approval process according to their scope.
- Assist owners of policies in drafting the policy, identifying all related supporting documents, and coordinating/assisting in the drafting of supporting documents.
- Provide constructive feedback in a timely manner to staff on changes and improvements within documents and document writing.
- Assist in the creation of end-to-end cross-functional process maps and entry into the policy and procedure repository. Publish approved polices to the policy and procedure repository.
- Conduct quality control checks to ensure compliance with guidelines, specifications, formats, and deadlines.
- Use writing skills and extraordinary attention to detail to evaluate, uphold, and implement organization content standards.
- Follow internal policies, standard operating procedures, and state and federal regulatory requirements related to policy management and retention; responsible for ensuring all policies and procedures are in compliance with records retention policies.
- Actively manage the operations policy and procedure repository to ensure all documents are reviewed and updated as needed prior to their review due date by all operations staff and cross department staff who are listed as reviewers and approvers.
- Handle inquiries and provide continuing education sessions about drafting, reviewing, and revising policies and procedures to ensure understanding of the defined documentation life cycle.
- Support key managers in Operations Department.
- Monitor and report out key metrics on the document review and approval process.
Organizational Responsibilities
- Perform work in alignment with the organization’s mission, vision and values.
- Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
- Strive to meet annual business goals in support the organization’s strategic goals.
- Adhere to the organization’s policies, procedures and other relevant compliance needs.
- Perform other duties as needed.
Knowledge, Skills and Abilities Required
- Understanding of federal Medicare regulations and state Medicaid rules (OARs)
- Strong ability to communicate information effectively both verbally and in writing in an individual or group setting
- Ability to draft, edit, and educate on policies and procedures
- Strong interpersonal skills
- Proficient in Microsoft Word, Excel, Power Point Windows and SharePoint
- Strong problem solving, organizational and detail orientation skills
- Effective coordination and collaboration skills
- Ability to be self-directed and work independently with little supervision
- Ability to maintain professional relationships with internal staff and departments
- Ability to work in an environment with diverse individuals and groups
Physical Skills and Abilities
Lifting/Carrying up to 10 Pounds
Pushing/Pulling up to 0 Pounds
Pinching/Retrieving Small Objects
Crouching/Crawling
Reaching
Climbing Stairs
Repetitive Finger/Wrist/Elbow/
Shoulder/Neck Movement
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More than 6 hours/day
Standing
Walking
Sitting
Bending
Seeing
Reading
Hearing
Speaking Clearly
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0 hours/day
More than 6 hours/day
More than 6 hours/day
More than 6 hours/day
More than 6 hours/day
Cognitive and Other Skills and Abilities
Ability to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution, accept managerial direction and feedback, and tolerate and manage stress.
Education and/or Experience
- Minimum 2 years’ experience working with healthcare regulations relating to Medicaid or Medicare
- Minimum 6 months’ experience writing and/or editing corporate policies and procedures, operations manuals
- Experience with SharePoint and PolicyTech or other document management systems
