Job Description
The Role
As a Medical Policy Clinical Analyst, you will play a key role in reviewing and enhancing clinical policies, researching new policies, and ensuring compliance with Medicare/Medicaid regulations. You'll act as a subject matter expert, supporting the business by interpreting regulations and providing insightful recommendations.
Key Responsibilities
Conduct detailed analysis and research to identify and interpret medical policy regulations, ensuring compliance with industry standards.
Collaborate in developing meaningful, compliant policies using your knowledge of Medicare/Medicaid regulations and compliance principles.
Research and interpret complex statutes and regulations, providing clear explanations of organizational and process-related issues.
Support the Medical Policy Governance Process, ensuring adherence to policy development protocols.
Contribute to team initiatives by sharing insights and supporting collective efforts.
Help communicate critical information across teams and departments to ensure alignment with medical policy objectives.
What You'll Need to Succeed
A Bachelor's Degree or equivalent experience.
Current, active CA Registered Nurse (RN) license, or an LVN with relevant experience.
AAPC (CPC) or AHIMA (CCS or CCS-P) certification is a plus.
3+ years of experience in medical coding (CPT, ICD-9, ICD-10).
At least 2 years of experience as an analyst in the healthcare field.
Strong knowledge of Medicare health plans and regulatory compliance, particularly CMS Medicare/Medicaid regulations.
Expertise in clinical policy and ability to conduct research and analysis based on evidence or direct experience.
Excellent communication and interpersonal skills to collaborate effectively with cross-functional teams.
Proficiency with Tableau and/or Alteryx, as well as intermediate to advanced skills in Microsoft Office.
Strong analytical and problem-solving skills, with the ability to adapt and thrive in a fast-paced, dynamic environment.
Why Join Us?
Competitive salary range: $80,300 to $128,500 per year
Remote work flexibility
Annual employee bonus program
Comprehensive wellness program to support your health and wellbeing
Generous paid time off (PTO), plus 11 paid holidays and additional floating holidays
401(k) retirement plan with employer match and contributions
Employee recognition program to celebrate your achievements
Tuition reimbursement for your continued learning
The chance to be part of a team that makes a positive impact on our members and the community every day!
Ready to Join Us?
We're always looking for talented individuals to join our team. If you have the qualifications and passion to help improve healthcare policies, we encourage you to apply today!
Employment Type: Full-Time
Salary: $ 80,300.00 128,500.00 Per Year
Job Tags
Holiday work, Full time,