Policy Lifecycle & Compliance:
- Own the accountability for the development and maintenance of clinical and reimbursement policies.
- Ensuring perfect alignment with CMS regulations.
- Serve as the authority on Medicare guidelines.
Medicare Regulatory SME:
- Specifically interpreting and operationalizing NCDs, LCDs, and general national coding guidelines.
- Ensure existing clinical and reimbursement policies are current and up to date.
- Reflect the latest regulatory requirements.
AI-Driven Evolution:
- Lead the implementation of AI initiatives to automate the monitoring of reimbursement policies.
- Utilize advanced LLMs (such as Claude, Gemini, and ChatGPT) to conduct regular deep research on ongoing industry trends.
Clover Health
Clover Health focuses on improving the health of its members by leveraging technology and data-driven insights to provide personalized, high-quality care. They aim to empower their members by helping them navigate the complexities of healthcare and live healthier lives and are passionate about making healthcare easier, more affordable, and more accessible for everyone.