Job Title: Medical Policy Analyst

Location: Reston, VA (Remote)

Duration: 12 Months Contract

PURPOSE :

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.

KNOWLEDGE, SKILLS AND ABILITIES (KSAs) :

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 -PREFERRED