Job Description
Position Overview
As a Medical Policy Clinical Analyst, you will play a crucial role in reviewing, evaluating, and improving clinical policies. You will also research new policies and provide responses to inquiries related to Medicare/Medicaid regulations. This position allows you to support the business by serving as a subject matter expert in regulatory interpretation.
Key Responsibilities
Provide analytic and research support for identifying and interpreting medical policy regulations.
Use your knowledge of compliance principles and Medicare/Medicaid regulations to develop meaningful, compliant policies.
Research, interpret, and break down complex statutes, regulations, and organizational issues.
Support the Medical Policy team by ensuring alignment with the Medical Policy Governance Process.
Assist with communications and collaboration efforts across teams.
Contribute to team success by accomplishing related tasks and sharing results with colleagues.
Qualifications
Bachelor's Degree or equivalent professional experience.
Active, current Registered Nurse (RN) licensure required. LVN may be considered with appropriate experience.
Certification from AAPC (CPC) and/or AHIMA (CCS or CCS-P) is a plus.
3+ years of experience in medical coding (CPT, ICD-9, ICD-10).
2+ years of experience in an analyst role.
Experience in a Medicare health plan environment, particularly in coding or compliance.
Expertise in CMS Medicare/Medicaid regulations required.
Strong communication skills with experience coordinating across multiple departments.
Advanced analytical skills and the ability to solve problems effectively.
Ability to conduct clinical research and literature searches to support clinical policy analysis.
Working knowledge of clinical policies and understanding of managed care industry trends.
Excellent organizational skills with the ability to manage time and work independently.
Strong team player with the ability to collaborate and learn in a dynamic, cross-functional environment.
Demonstrated ability to prioritize multiple tasks and work in a fast-paced environment.
Proficiency in Microsoft Office and familiarity with tools such as Tableau and/or Alteryx.
What We Offer
Competitive base salary range: $80,300 to $128,500 per year.
Remote work options available.
Annual employee bonus program.
Robust wellness program and generous paid time off (PTO).
Eleven paid holidays per year, plus one floating holiday and one birthday holiday.
Excellent 401(k) retirement savings plan with employer match and contributions.
Employee recognition program to celebrate achievements.
Tuition reimbursement opportunities for continuing education.
The chance to join a team dedicated to making a meaningful impact in the community and improving members' lives.
Apply Today
We are always seeking talented professionals to join our team. If you're passionate about healthcare policy, compliance, and making a difference, we encourage you to apply now!
Employment Type: Full-Time
Salary: $ 80,300.00 128,500.00 Per Year
Job Tags
Holiday work, Full time,