Medical Policy Analyst
Medical Policy Analyst
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Salary Not Disclosed
1 Vacancy
Job Description
Reach me on: Email: Tel: (240)
Position: Medical Policy Analyst
Location: Reston VA #REMOTE
Duration: C2H
Job Description:
- Under guidance of department Manager the Medical Policy Analyst will research develop and coordinate the distribution and dissemination of less complex medical policies in support of corporate philosophy provider and member contracts and accepted standards of medical practice.
- Bachelors or masters degree in nursing or related health care discipline.
- Coursework in technical writing and statistics.
- Ability to analyze essential facts make timely and sound decisions resolve performance and jobrelated issues. Demonstrated desire to share knowledge and work as a team.
- Excellent written and verbal communication skills and the ability to present to internal clients of all levels.
- Working knowledge of medical insurance and managed care principles and knowledgeable of CPT and ICD10 coding systems. Knowledge of all types of medical necessity decisions including various places of service and provider types.
- Knowledge of principles practices evidencebased guidelines and standardized processes and procedures for evaluating medical support operations business practices.
LICENSES AND CERTIFICATIONS:
- RN Registered Nurse State Licensure and/or compact State Licensure REQUIRED
- Certified Coder (CCS or CPC) AHIMA or AAPC
ESSENTIAL FUNCTIONS:
- Performs indepth research on topics identified as actual or potential medical policies. Evaluates current peerreviewed articles and other literature to determine its appropriateness for support of and inclusion in policies. Assesses and communicates impact of information on company business or medical policy.
- Writes evidencedbased medical policies/operating procedures in relation to legislative mandates new technology assessments contractual provisions corporate philosophy and accepted standards of medical practice in order for them to be applied uniformly and consistently by across all lines of business.
- Maintains the Medical Policy Reference Manual (MPRM) including resource files and publications. Ensures dissemination of policies and procedures to and from the Medical Policy Implementation Team and to other appropriate departments.
- Ensures maintenance and accuracy of the online versions of the MPRM as well as respond to questions from business units throughout the organization providing written clarification of existing policies new policy development emerging studies trends and other interest related to medical policy guidelines
Thanks & Regards
LAXMAN
KMM Technologies Inc.
CMMI Level 2 ISO 9001 ISO 20000 ISO 27000 Certified
Tel: (240)Email:
Employment Type
Full Time
