Associate Director of Medical Policy

The Associate Director, Medical Policy provides day-to-day leadership for the development, implementation and ongoing maintenance of the AMPS medical and coding payment policy library. In collaboration with the Senior Director, Medical Policy, this role establishes priorities for new policy development and existing policy enhancements based on clinical evidence, coding and reimbursement guidance, operational needs, regulatory requirements, and client priorities. A key responsibility of the position is leading, mentoring, and developing U.S.-based and global policy team members while promoting consistency, quality, and accountability across the policy development process. The Associate Director also serves as a subject matter expert, providing guidance to internal stakeholders and clients on policy requirements, interpretation, application, and implementation.

Job Responsibilities:

• Oversee the end-to-end development of medical, coding, and payment policies, including research, drafting, review, approval, implementation, and ongoing maintenance. Including participation in the development and enhancement of system functionality to support the implementation, scalability, and expansion of payment integrity policies.
• Ensure the medical policy library is accurate, current, organized, and reviewed on an established schedule.
• Serve as a subject matter expert resource for medical coding, reimbursement, payment integrity, and medical policy questions.
• Train and onboard new employees and mentor U.S. and global team members to strengthen policy research, interpretation, documentation, and writing capabilities.
• Establish and maintain standards for policy development to promote accuracy, consistency, clarity, and appropriate supporting documentation.
• Oversee the distribution and communication of medical policies to clients and ensure client-specific policy requirements are appropriately coordinated.
• Manage and facilitate policy-related operational requests, research inquiries, and special projects.
• Partner with the Senior Director of Medical Policy and other clinical, coding, operational, and business stakeholders to support policy strategy and execution.
• Serve as a primary point of coordination between the Medical Policy team and internal and external stakeholders.

Skills and Abilities:

• Ability to assess the quality of clinical and coding evidence and explain how it supports a policy decision.
• Clear writing and editing skills, including the ability to explain payment policy to research analyst, and client contacts.
• Ability to coach research analyst, team leads and managers to reconcile differing interpretations, and keep multiple policy reviews on schedule.

Education and Experience:

• Experience developing, reviewing, and maintaining medical or coding payment policies in a pre-payment integrity organization, or comparable healthcare setting.
• Experience interpreting medical records, coding guidance, and payer policies to support medical claims review or reimbursement decisions.
• Experience leading policy projects and training or mentoring staff. Experience supporting teams across locations is preferred.
• A bachelor’s degree or higher in a clinical or healthcare related discipline, health information management, healthcare administration, or a related field is required; equivalent relevant experience is preferred.
• A professional medical coding credential or a clinical background relevant to medical policy is preferred.

Physical Requirements:

Work involves frequent computer use to research, draft, and review policies and related materials.

Regular verbal and written communication with team members, clinical reviewers, and clients is required.

Advanced Medical Pricing Solutions (AMPS) provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.