Medical Policy Research Analyst

Our client is a leading healthcare technology & service company that provides solutions for healthcare organizations, has a unique experience base, extensive healthcare information and advantaged technology applications which create value through reduced medical costs, reduced administrative costs and improved care coordination.


Medical Policy Analysts hold the responsibility for ensuring that the rule library is accurate, up-to-date, and complete. Medical Policy is at the very core of client's products and services. The Analyst provides iron-clad research that supports client's ability to provide value to its customers.
REQUIREMENTS
EDUCATION/CERTIFICATION: Professional coder certification (CPC or CCS-P) or LPN or RN with medical coding knowledge.


REQUIRED KNOWLEDGE:Prior experience in developing medical payment policy edits.


EXPERIENCE REQUIRED:Minimum three years experience in claims adjudication or utilization review working for a managed care or health care insurance company


Assumes responsibility for keeping client's rule library up-to-date with the most current and accurate information.
Identify necessary changes to existing library rules through researching, reviewing and interpreting coding and billing professional journals/industry publications, periodicals, and governmental regulations, new medical policy edits and maintenance of existing edits.
Complete reviews of assigned global medical policies accurately and on a timely basis.
Provide general support to internal staff regarding rules and perform client related research as directed by the medical policy manager.
Maintains and updates all rule editorial information in the Oracle database through the update function in the RMR application.