Reimbursement Policy Analyst III

Medica•St. Louis, MO

4d•Hybrid

About The Position

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued. Responsible for Medica's Reimbursement Policies, including annual maintenance, implementation, research, drafting and presenting policy recommendations for committee vote and coordination of claims system changes to support claim payment accuracy. Performs other duties as assigned.

Requirements

Bachelor's degree or equivalent experience in a related field
5+ years of work experience beyond degree

Nice To Haves

Advanced Excel skills
Coding certification strongly preferred: CPC, CPC-P, COC, RHIT, CSS (preferred someone credentialed in facility coding)
Function as an SME for reimbursement policies
Able to analyze and translate data (to determine financial impact) and develop recommendations
Ability to prepare and develop diverse information into effective presentations
Experience leading/facilitating process improvement teams

Responsibilities

Collaborate closely with network management and configuration to troubleshoot claims issues and update systems to resolve complex issues
Present insights and recommendations in a way that enables leaders to make confident, data-informed decisions
Serve as subject matter expert in reimbursement policy for all lines of business