[Hiring] Senior Managed Care Policy Analyst @Experian

Role Description

As Senior Managed Care Policy Analyst , you will manage the accurate representation of medical rules/edits from any source. You'll build and use all tables and work with clients regarding Technical Support Issues identified. You may review and make recommendations regarding Level I and Senior coding, placement, and logic. You'll be responsible for:

• Identifying necessary and potential changes to existing medical rules through review of current and historically available hardcopy medical policies, transmittals and bulletins.
• Extracting information from resources and translating it to form appropriate logic for rules, documentation, and quality assurance review.
• Completing Clinical Transaction Engine table builds (used by eCN Medical Necessity and ClaimSource) with integrity checks.
• Reviewing edit modification for medical procedures for clear representation of varying levels of ICD-10-CM diagnoses.
• Assigning CPT/HCPS codes for PreCertification product table(s) where contractor supplies narrative condition only.
• Participating in review of National NCD's for National policies, assigning appropriate diagnosis and procedural codes for review by Director.
• Independently preparing and making appropriate adjustments to any data editorial for release to production.
• Preparing reports and documents for Director review including coding trends, documentation requirements, related payer changes, and concerns.
• Completing reviews of medical policies and publications and integrating them into the required database.
• Identifying patterns of improper coding or errors in policies and publications and resolving and recommending alternate codes.
• Completing in-depth, independent reviews of issues forwarded by Compliance Support and composing responses for clients.
• Maintaining all medical rules editorials in the appropriate database using programmatic tools.
• Analyzing data and drawing conclusions.
• Being responsible for accurate research of resources that update critical information on a scheduled basis.
• Staying up to date with current coding issues.

Qualifications

• Associate's or Bachelor's degree in the Life Sciences or Accredited Record Technician's certification (ART) or Certified Procedural Coder certificate (CPC) or outpatient Medical Coder experience or an equivalent combination of training, education, and experience.
• 4+ years experience with and knowledge of Current Procedural Terminology (CPT) Coding, and International Classification of Disease (ICD-10) Codes required.
• Experience researching and drawing conclusions regarding medical edits.
• Knowledge of Medicare reimbursement guidelines.
• Knowledge of Medical Terminology.
• Knowledge of anatomy and physiology.
• Standard English grammar/usage and proper telephone communication.
• Ability to write in a clear and understandable manner.
• Previous Healthcare experience.

Benefits

• Great compensation package and bonus plan.
• Core benefits including medical, dental, vision, and matching 401K.
• Flexible work environment, ability to work remote, hybrid or in-office.
• Flexible time off including volunteer time off, vacation, sick, and 12 paid holidays.