Senior Managed Care Policy Analyst (Remote)

As Senior Managed Care Policy Analyst you will manage the accurate representation of medical rules/edits from any source. Youll build and use all tables and work with clients regarding Technical Support Issues identified. You may review and make recommendations regarding Level I and Senior coding placement and logic. Youll be responsible not only for assisting with building tables associated with new products or technology but also the release and review of content into production for client use. Youll make recommendations and assist with data/tables for new products. You will report to the Senior Director Compliance Data.

You will:

• Identify necessary and potential changes to existing medical rules through review of current and historically available hardcopy medical policies transmittals and bulletins. This includes revision and retirement of existing policies and the addition of new policies.
• Extract information from resources and translate information needed to form appropriate logic for rules documentation and quality assurance review. Complete Clinical Transaction Engine table builds (used by eCN Medical Necessity and ClaimSource) with completion of integrity checks Review of edit modification for medical procedures for clear representation varying levels of ICD-10-CM diagnoses.
• Assign CPT/HCPS codes for PreCertification product table(s) where contractor supplies narrative condition only. Also participate in review of National NCDs for National policies assigning appropriate diagnosis and procedural codes to be reviewed by Director and for strategic inclusion into Medicare medical edits.
• Independently prepare and make appropriate adjustments to any data editorial for release to production
• Prepare reports and documents for Director review including coding trends documentation requirements related payer changes and concerns.
• Complete reviews of medical policies and publications and its integration into the required database. Identify patterns of improper coding or errors in policies and publications and can resolve and recommend alternate codes or code representation is appropriate table(s) (Diagnosis CPT/HCPCS CCIEdits)
• Complete in-depth independent reviews of issues forwarded byCompliance Support. Compose responses and discuss with clients.
• Maintain all medical rules editorials in the appropriate database using programmatic tools.
• Analyze data and draw conclusions.
• Be responsible for accurate research of resources that update critical information on a scheduled basis. Stay up to date with current coding issues.

Qualifications :

• Associates or Bachelors degree in the Life Sciences or Accredited Record Technicians certification (ART) or Certified Procedural Coder certificate (CPC) or outpatient Medical Coder experience or an equivalent combination of training education and experience
• 4 years experience with and knowledge of Current Procedural Terminology (CPT) Coding and International Classification of Disease (ICD-10) Codes required. Must understand and retain coding information and transfer that information into completed product data.
• Experience researching and drawing conclusions regarding medical edits
• Knowledge of Medicare reimbursement guidelines
• Knowledge of Medical Terminology
• Knowledge of anatomy and physiology
• Standard English grammar/usage and proper telephone communication
• Write in a clear and understandable manner
• Previous Healthcare experience

Additional Information :

Benefits/Perks:

• Great compensation package and bonus plan
• Core benefits including medical dental vision and matching 401K
• Flexible work environment ability to work remote hybrid or in-office
• Flexible time off including volunteer time off vacation sick and 12 paid holidays
• Explore all our exciting benefits here: Experian our people and culture set us apart. Were committed to creating an environment where everyone feels they belong and can excel. From inclusion and authenticity to work/life balance development wellness collaboration and recognition we focus on what matters. Our people-first approach has earned us global recognition: Worlds Best Workplaces 2024 (Fortune Top 25) Great Place To Work 2025 in 26 countries and Glassdoor Best Places to Work 2024 among others.

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  Our compensation reflects the cost of labor across several U.S. geographic markets. The base pay range for this position is listed above. Within this range individual pay is determined by work location and additional factors such as job-related skills experience and education. You will be also eligible for a variable pay opportunity.

  Experian is proud to be an Equal Opportunity Employer for all groups protected under applicable federal state and local law including protected veterans and individuals with disabilities. If you have a disability or special need that requires accommodation please let us know at the earliest opportunity.

  #LI-Remote This is a remote position.

  
  

  Remote Work :

  Yes

  
  

  Employment Type :

  Full-time