Senior Medical Policy Analyst
About The Position
Develops medical/dental and reimbursement policies for coverage guidance of new drugs, technology, medical/dental procedures and clinical codes. Initiates the process for internal and external review of corporate medical/dental and reimbursement policies to meet all compliance regulations. Responds to internal and external inquiries regarding policies, benefit application and reimbursement strategies. Represents the Healthcare Division as clinical or coding advisors. Analyzes clinical/dental service codes that are applicable to medical/dental and reimbursement policy, including but not limited to: research of newly developed codes, review of claims data, and assessment of system configuration.
Requirements
- RN, LPN or Dental Assistant, based on area of focus
- 3+ years of experience in related field
- AAPC Certified Professional Coder
Responsibilities
- Initiates and coordinates the internal and external reviews of medical/dental and reimbursement policies as required by regulatory agencies.
- Identifies and initiates the medical/dental policy development process for the modification or creation of policies to address Plan needs as they occur.
- Gathers appropriate resource information necessary for policy/technology assessment including, but not limited to, scientific literature searches, approval status by appropriate governmental regulatory bodies, practice guidelines, relative position statements, and materials from the Blue Cross and Blue Shield Association Technology Evaluation Center.
- Analyzes, makes recommendations, and prepares initial drafts of policies.
- Oversees the ongoing maintenance of the internal and external medical policy websites and the on-line medical policy manual to ensure data is current and accurate.
- Identifies the need for, and drafts, public policy notifications to providers and members, communicating new medical/dental policy guidelines or impactful policy changes.
- Serves as the Subject Matter Expert for applicable coding and policy issues that arise both internally and externally.
- Serves as a resource to internal stakeholders (i.e. sales and marketing, compliance) for medical/dental integrated benefit design.
Benefits
- Annual Incentive Bonus
- 401(k) with employer match
- Paid Time Off (PTO)
- competitive health benefits
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
