Senior Medical Policy Analyst

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.
• 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.

Requirements

• RN, LPN or Dental Assistant, based on area of focus
• 3+ years of experience in related field
• AAPC Certified Professional Coder
• Salary Range
• *Based on annual corporate goal achievement and individual performance.
• $81,068.00 - $129,708.00
• _____________________________________________________________________

Benefits

Additional Information

Job Description 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.

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Company Intel

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