Medical Policy Analyst

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 master’s 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 job-related 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 ICD-10 coding systems. Knowledge of all types of medical necessity decisions including various places of service and provider types.
• Knowledge of principles, practices, evidence-based 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 in-depth research on topics identified as actual or potential medical policies. Evaluates current peer-reviewed 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 evidenced-based 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 on-line 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) 800-0039 |Email: [email protected]