Medical Policy Project Analyst

Louisiana Health Service & Indemnity Company • Haughton, LA

269d

About The Position

This position will handle multiple complex enterprise projects and assignments utilizing strong project management, analytical and technical skills. This position will work closely with the Manager of Medical Policy and Medical Appeals to effectively manage and coordinate implementation of projects as defined by the Medical Policy unit work initiatives and goals.

Requirements

• Bachelor's in nursing or a related health care field is required.
• In lieu of a Bachelor's degree, a current, unrestricted RN license in the state of Louisiana and/or in the required jurisdictions, or where services are provided can be used.
• In lieu of a Bachelor's degree, a current, unrestricted LPN license in the state of Louisiana and/or in the required jurisdictions, or where services are provided to practice in Louisiana as well as two years of related experience can be used.
• In lieu of a Bachelor's degree, four years of directly related research, analysis and application of medical coding experience can be used.
• 7 years of experience to include research, analysis, and application of CPT, HCPCS, CDT and ICD-10-CM coding is required.
• The 7 years of experience must include at least some experience in each of the following areas: provider appeals, managed care, clinical editing concepts, disease processes, and/or medical policy procedures.
• Demonstrated experience with provider and/or payor healthcare claims systems is required.
• Experience verifying healthcare claims is preferred.

Nice To Haves

• Leadership or supervisory experience is preferred.
• Certified professional coding credentials for CPT, HCPCS, and/or ICD-10-CM medical coding systems is preferred upon hire but must be attained within 90 days of moving into the job.
• Additional coding certification is preferred.

Responsibilities

• Provides research analysis and support for specific projects, implementations, ongoing maintenance and enhancements of multiple complex enterprise wide systems to continue to develop the Medical Policy Strategy.
• Provides medical policy analysis to assign appropriate coding, designate claims processing scenarios to ensure accurate claims payment and interacts with processing staff or manages enterprises to coordinate ongoing up to date claims payment instruction.
• Defines data, business and user requirements and translates into detailed system requirements and plans to implement and support ongoing Medical Policy activities.
• Prepares reports to management defining problems, evaluation and possible solution to system issues to monitor impact and ensure quality of implementation.
• Coordinates and participates in user groups and other committees as needed to act as a subject matter expert to provide input from Medical Policy Strategies and Goals.
• Perform other job-related duties as assigned, within your scope of responsibilities.

Benefits

• Resources to live well and be healthy.
• Opportunities for continued learning and professional development.
• Support for serving local communities.

What This Job Offers

• Industry: Funds, Trusts, and Other Financial Vehicles
• Education Level: Bachelor's degree