AI-Driven Clinical & Reimbursement Policy Analyst

Jobgether; United States; Remote; USD 107,000 - 130,000; Full time

Benefits offered by this job

Annual base salary 107000–130000 USD

Equity opportunities

Performance-based bonus program

401(k) with company matching

Medical, dental, vision insurance

Remote-first culture

Flexible paid time off

No-Meeting Fridays

Monthly company holidays

Mental health resources

Professional development programs

Employee Stock Purchase Plan (ESPP)

Home office expense reimbursement

Monthly cell phone & internet stipend

Parental leave

Job summary

Jobgether seeks a Business Analyst, Clinical & Reimbursement Policy, to oversee policy accuracy, CMS alignment, and AI-enabled process improvements in US healthcare. You will manage policy lifecycles, interpret NCDs/LCDs, and collaborate with Clinical, Claims, and Compliance teams to ensure accurate claims adjudication and regulatory compliance, while driving automation via LLMs.

This role requires strong vendor management, data analysis, and ability to translate complex rules into actionable

Qualifications

• 5+ years in healthcare claims or reimbursement policy with Medicare Advantage focus.
• Ability to interpret NCDs/LCDs and translate into policy/functional specs.
• Experience leading vendor partnerships and ensuring quality standards.

Responsibilities

• Oversee policy accuracy, regulatory alignment, and policy lifecycle maintenance.
• Lead AI-driven monitoring initiatives and utilize LLMs for research and trend analysis.
• Collaborate with Clinical, Claims, Compliance, Configuration, and Data Science teams.
• Translate regulatory and business requirements into actionable specifications.
• Manage external vendor relationships and conduct data-driven performance reviews.
• Develop proactive monitoring to detect policy changes before impacts claims.
• Analyze dashboards and KPIs to inform strategic decisions and risk management.

Skills

Healthcare claims

Medicare Advantage

Policy lifecycle management

AI-powered monitoring

Vendor management

Data-driven decision making

Regulatory research

Dashboards & analytics

Education

Professional coding certification (CPC/CCS/COC/CIC)

Tools

ChatGPT

Claude

Gemini

Job description

Jobgether seeks a Business Analyst, Clinical & Reimbursement Policy, to oversee policy accuracy, CMS alignment, and AI-enabled process improvements in US healthcare. You will manage policy lifecycles, interpret NCDs/LCDs, and collaborate with Clinical, Claims, and Compliance teams to ensure accurate claims adjudication and regulatory compliance, while driving automation via LLMs.

This role requires strong vendor management, data analysis, and ability to translate complex rules into actionable