Medical Policy Analyst
Medical Policy Analyst
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$ 28 - 45
1 Vacancy
Job Description
Job Description
The Medical Policy Team within the Office of Healthcare Policy & Authorization (OHPA) is seeking a qualified Medical Policy Analyst to join our dynamic team. This position plays a key role in analyzing interpreting updating and overseeing medical coverage policies while ensuring compliance with state and federal regulations.
The successful candidate will contribute to the development of detailed medical program guidance collaborate with internal teams and help manage core policy functions that impact healthcare delivery across the state.Applicants must have at least four (4) years of experience in one or more of the following areas:
- Professional experience working under the employment of Medicaid
- Certification with the American Academy of Professional Coders (AAPC)
- Certification with the American Health Information Management Association (AHIMA)
The ideal candidate hired for this position will have:
- Strong and well-developedtechnical writing skills
- Experience withgovernment healthcare programs especially Medicaid
- Proficiency in CPT HCPCS ICD-10-CM and ICD-10-PCS coding systems
- Familiarity withclaims submission denial resolution and remittance processes
- Knowledge of theIntegrated Outpatient Code Editor (I/OCE)National Correct Coding Initiative (NCCI) andMedicare Severity Diagnosis Related Groups (MS-DRG)
- Proven ability to interpret federal and state statutes and translate them into operational policy
Key Responsibilities:
- Consult on policy recommendations aligned with coding regulations and standards
- Analyze and review claims to assess compliance with coverage criteria
- Design and revise medical coverage policies in accordance with applicable laws
- Set project goals manage resources track progress and evaluate outcomes
- Coordinate with internal stakeholders to ensure successful policy implementation
Note: as of April 8 2024 DHHS employees will be working a hybrid schedule which includes 2 office days per week and 3 telework days.
Why work for the Utah Department of Health and Human Services In addition to the richbenefits the State of Utah offers the department offers:
- On-site fitness center for a minimal membership fee
- UTA Eco Pass at a discounted monthly rate
- Teleworking opportunities with a minimum 2 office days per week beginning 04/2024.
- On-site day care centerat the Cannon Health Buildingwith First Steps Day Care - contact for rates and availability or
For more information on the Utah Department of Health and Human Services please clickhere.
If offered this position your employment will be contingent upon passing a background check and review. There will be no cost to you for this check. This check will include fingerprinting which will be available at variousDHHSlocations for your convenience. Fingerprinting will be completed prior to your first day of employment. You may review the policy by clickinghere.
Supplemental Information
- Effective July 1 2021 State of Utah Employees must either reside in Utah or be in the process of relocating to Utah within 30 days of their start date.
- This position may currently be a hybrid of both in-office and remote work days. Please note a persons eligibility for remote work is establisted by agency management and is subject to change at their discretion at any time and for any reason.
- Risks found in the typical office setting which is adequately lighted heated and ventilated e.g. safe use of office equipment avoiding trips and falls observing fire regulations etc.
- Typically the employee may sit comfortably to perform the work; however there may be some walking; standing; bending; carrying light items; driving an automobile etc. Special physical demands are not required to perform the work.
- Please include with your application at least three recent professional references (within the last five years).
Required Experience:
IC
Employment Type
Full-Time
