[Hiring] Payment and Medical Policy Coordinator @CareFirst

Role Description

The Policy Coordinator will support the end-to-end implementation of medical and payment policies by coordinating cross-functional activities required to operationalize policy decisions. This role ensures business readiness across impacted functions, including claims, configuration, provider communications and operations, and provides support during testing, implementation, and post-implementation validation. We are looking for an experienced professional to work remotely from within the greater Baltimore/Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities.

• Coordinates cross-functional activities required to implement medical and payment policy changes, including alignment across claims, configuration, provider operations, network management, and compliance teams.
• Tracks key milestones and ensures readiness for policy go-live.
• Supports business readiness activities, including impact assessments, readiness checklists, and coordination of implementation plans.
• Works with stakeholders to identify operational, staffing, and workflow impacts associated with policy changes.
• Coordinates testing activities related to policy implementation, including user acceptance testing (UAT), validation of claims adjudication logic, and issue tracking/resolution.
• Ensures testing results are documented and communicated to stakeholders.
• Maintains implementation documentation, including timelines, status reports, risks, and dependencies.
• Provides regular updates to leadership and ensures transparency across teams.
• Supports post-implementation monitoring by coordinating issue tracking, identifying gaps in execution, and escalating risks or defects to appropriate stakeholders for resolution.

Qualifications

• Bachelor's Degree in Health Administration, Business, Finance or related discipline OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
• Preferred: Certified Coder (CCS or CPC)-AHIMA or AAPC AAPC Certified Professional Coder (CPC) or AHIMA Certified Coding Specialist (CCS).
• Experience in health plan operations, project coordination, policy implementation, claims operations, or related functions.
• Preferred: Experience working in a health plan environment (Medical Policy, Payment Policy, Claims, or Operations).
• Preferred: Experience coordinating cross-functional projects or implementations.
• Preferred: Familiarity with claims systems, configuration processes, or policy governance.

Requirements

• Strong organizational and coordination skills across multiple teams and stakeholders.
• Ability to manage multiple workstreams and meet deadlines.
• Strong communication skills with ability to translate policy decisions into operational tasks.
• Working knowledge of managed care, claims processes, and policy implementation workflows.
• Ability to identify risks, track issues, and escalate appropriately.
• Use of Microsoft Office applications (Excel, PowerPoint, Word) and project tracking tools.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
• Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Benefits

• Comprehensive benefits package.
• Various incentive programs/plans.
• 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).