Research Manager

Advanced Medical Pricing Solutions•Alpharetta, GA

48m

About The Position

The Research Manager partners closely with the Senior Director of Medical Policy to support the growth, quality, and ongoing maintenance of the AMPS Medical Policy Library. This role serves as a key liaison to the Global Research Team, providing

Requirements

Bachelor’s degree is preferred, or equivalent combination of education and experience.
Support the expansion and ongoing maintenance of the Medical Policy Content Library in alignment with industry standards and regulatory updates.
Clinical experience preferred but not required.
Minimum of 3 years of experience with CPT, ICD-10, and HCPCS coding.
· Minimum of 2 years of experience in claims adjudication, medical or payment policy, utilization review, or related roles within a managed care or healthcare insurance environment; familiarity with claims management and billing systems preferred.
Minimum of 2 years of customer service experience in a healthcare-related setting.
Strong research skills with demonstrated knowledge of CMS guidelines, regulatory compliance requirements, and medical payment policy.
Solid understanding of medical terminology.
Proven ability to handle confidential and sensitive information with professionalism and discretion.
Ability to work independently while demonstrating a strong track record of success in collaborative team environments.
Excellent written, verbal, and interpersonal communication skills.

Nice To Haves

Clinical experience preferred but not required.
· Minimum of 2 years of experience in claims adjudication, medical or payment policy, utilization review, or related roles within a managed care or healthcare insurance environment; familiarity with claims management and billing systems preferred.

Responsibilities

Support the expansion and ongoing maintenance of the Medical Policy Content Library in alignment with industry standards and regulatory updates.
Translate industry references, clinical guidelines, and regulatory directives into clear, accurate AMPS medical policies.
Serve as the primary point of contact for the Global Research Team, providing ongoing support, direction, and feedback related to medical policy development.
Provide training, coaching, and mentoring to the Global Research Team to ensure consistent quality and performance.
Participate in and support User Acceptance Testing (UAT), including the development of test scenarios to validate new and updated policies prior to production release.
Oversee the Client Inquiry process to ensure responses are accurate, concise, and delivered in a timely manner.
Conduct data analysis to identify billing trends and patterns that may inform new policy development or highlight potential risks to existing policies.
Identify opportunities for system enhancements that support policy expansion, accuracy, and efficiency.
Support continuous process improvement initiatives to promote accuracy, consistency, and repeatable outcomes.
Build and maintain trust-based, professional relationships with internal stakeholders and, when required, external business partners.
Apply project management principles to initiate, develop, and manage medical payment policies.
Proactively contribute expertise and insights to add value to departmental and client initiatives.
Perform other duties as assigned.