Senior Managed Care Policy Analyst (Remote) at Experian

You are a medical coding professional with at least four years of experience handling CPT and ICD-10 sets, plus a relevant degree or professional certification

Work type: remote

Location: United States

Salary: $57,111 – $98,993/yr

Type: Full-time

Summary

You are a medical coding professional with at least four years of experience handling CPT and ICD-10 sets, plus a relevant degree or professional certification like an ART or CPC. You understand how to translate clinical policies into technical rules and logic for healthcare software systems. **What makes it worth a look...** Experian offers a fully remote U.S. role with a base salary between $57,111 and $98,993 per year plus variable bonus opportunities. The position includes a comprehensive benefits package with medical, dental, vision, and matching 401K contributions. **You might be a good fit if you...** * Possess four or more years of experience in medical coding and policy research. * Have direct knowledge of Medicare reimbursement guidelines and medical necessity edits. * Can translate complex clinical documentation into structured table builds for database production. * Understand anatomy and physiology well enough to resolve improper coding patterns.

Job Description

## Job Description
As Senior Managed Care Policy Analyst, you will manage the accurate representation of medical rules/edits from any source. You'll 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. You'll 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. You'll 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 NCD's 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, CCI_Edits)


• 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.

• Associate's or Bachelor's degree in the Life Sciences or Accredited Record Technician's 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

• 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: [https://yourexperianbenefits.com/cand-index.html](https://yourexperianbenefits.com/cand-index.html)

Want to see what life at Experian is really like? Explore Experian Life on social or visit our careers site.

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.

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