Clinical Policy Coordinator

Wellfleet, a Berkshire Hathaway company, delivers customer-centric accident and health insurance, with quality service and uncompromising ethics. Wellfleet works to protect people against risk throughout every stage of life – from grade school to college to the workplace.

Founded in 1993 as Consolidated Health Plans (CHP), Wellfleet, headquartered in Springfield, Mass., is one of the nation’s leading providers of health and accident insurance products to the higher education market.

Are you an experienced Clinical Policy Coordinator? If so, we want you to join us in supporting the Wellfleet Healthcare Optimization team and Student Health block of business. Come grow with us!

The Clinical Policy Coordinator is responsible for providing administrative, operational, and research support for the Medical Technology Assessment Committee (MTAC) and other clinical policies and guidelines. This role supports the coordination of committee activities related to utilization management governance, including meeting preparation, evidence gathering, documentation, and follow-up actions associated with clinical review criteria, prior authorization requirements, and related committee decisions. The Clinical Policy Coordinator helps ensure MTAC activities are well organized, appropriately documented, and effectively communicated to support implementation across internal teams and delegated vendors.

The role supports enterprise clinical governance by evaluating emerging and updated procedure codes to ensure alignment with benefit strategy, utilization management standards, payment policy, and operational readiness.

• Coordinate MTAC meeting logistics, including calendar management, agenda development support, material preparation, and distribution of meeting documents.
• Assist in identifying, organizing, and researching topics for committee review in collaboration with internal stakeholders.
• Gather, collate, summarize, and distribute supporting materials for committee consideration, including electronic literature searches, technology assessments, regulatory references, and publications from professional associations, government agencies, and specialty societies.
• Support the collection and organization of input from physicians, clinical subject matter experts, and other stakeholders, as needed.
• Draft meeting minutes, maintain decision logs, and prepare related committee documentation for stakeholders and leadership.
• Assist with drafting and updating clinical review criteria, prior authorization guidelines, code lists, and other supporting materials based on committee direction.
• Coordinate follow-up actions resulting from committee decisions and support communication of approved changes to internal departments and delegated vendors.
• Maintain organized records of committee materials, supporting evidence, decisions, and implementation documentation.
• Support development and maintenance of policies, procedures, workflows, and templates related to MTAC operations.
• Assist with implementation activities associated with new or revised guidelines and criteria in coordination with internal teams and external partners.
• Review newly released and updated CPT/HCPCS codes to assess applicability to existing benefit structures, utilization management processes, and payment guidelines
• Conduct clinical and regulatory research to support evaluation of new procedures/services, including:
• Peer-reviewed literature
• Specialty society guidelines
• CMS/AMA publications
• Internal claims/utilization trends
• Ensure approved coding determinations are operationalized, including:
• Mapping CPT codes to benefit configurations
• Aligning codes with prior authorization rules and clinical edits
• Supporting configuration in claims/adjudication…