MEDICARE POLICY ANALYST

Next City; New York (NY); Remote; USD 106,000 - 130,000; Full time

Job summary

An innovative firm is seeking a Medicare Policy Analyst to leverage clinical knowledge and coding expertise in enhancing healthcare solutions. This role involves extensive research and data manipulation to improve billing and reimbursement processes nationwide. You will collaborate with a passionate team, tackling complex challenges while ensuring compliance with medical policies. If you're ready to make a significant impact in the healthcare sector and thrive in a collaborative environment, this opportunity is perfect for you!

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

Flexible Spending Accounts

Disability Benefits

Life Insurance

Paid Absences

Retirement Benefits

Qualifications

• 4 years of healthcare or medical coding experience required.
• Strong understanding of medical terminology and coding practices.

Responsibilities

• Research and analyze Medicare payment policies and update databases.
• Collaborate with team to implement solutions for medical billing.

Skills

Medical Coding

Data Analysis

Clinical Knowledge

Programming Thinking

Communication Skills

Education

Bachelor's Degree

High School Diploma/GED

Tools

MS Office

Excel

Health Information Systems

Job description

Thank you for your interest in working for our Company. Recruiting the right talent is crucial to our goals. On April 1, 2024, 3M Healthcare underwent a corporate spin-off leading to the creation of a new company named Solventum. We are still in the process of updating our Careers Page and applicant documents, which currently have 3M branding. Please bear with us. In the interim, our Privacy Policy here: Privacy Policy continues to apply to any personal information you submit, and the 3M-branded positions listed on our Careers Page are for Solventum positions. As it was with 3M, at Solventum all qualified applicants will receive consideration for employment without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Description:

Medicare Policy Analyst (Solventum)

3M Health Care is now Solventum

At Solventum, we enable better, smarter, safer healthcare to improve lives. As a new company with a long legacy of creating breakthrough solutions for our customers’ toughest challenges, we pioneer game-changing innovations at the intersection of health, material and data science that change patients' lives for the better while enabling healthcare professionals to perform at their best. Because people, and their wellbeing, are at the heart of every scientific advancement we pursue.

The Impact You’ll Make in this Role

In this position you will utilize your medical coding, billing, or clinical knowledge to develop software and data sets using information from national and state medical coverage policies. This involves extensive research of medical policies and utilizes clinical understanding to represent policies with medical terminology and medical codes such as CPTs, HCPCs, and ICDs. Key skills to succeed include the ability to manipulate data, think like a programmer, and draw upon a clinical background, medical coding, or reimbursement knowledge. You will be working with a small passionate team and be involved in projects that improve medical billing, coding, and reimbursement across the nation.

As a Medicare Policy Analyst, you will have the opportunity to tap into your curiosity and collaborate with some of the most innovative and diverse people around the world. Here, you will make an impact by:

• Researching and analyzing Medicare payment policies and regulatory changes in order to organize and update content in our proprietary database.
• Preparing and delivering new files and updates to customers.
• Corresponding with CMS or other payers to clarify policy ambiguities or publication errors. Responding to inquiries about our data or working with customers to resolve issues. Leading QA and analyses of data we build or acquire.
• Implementing solutions that help hospitals, clinics, and doctors comply with regulations and attain proper payment for medical care.
• Collaborating with skilled colleagues to devise solutions to tricky challenges.
• Determining how to best organize and represent information to meet client or software needs. Contributing ideas that advance and improve your team’s products & processes.

Your Skills and Expertise

To set you up for success in this role from day one, Solventum requires (at a minimum) the following qualifications:

Bachelor’s Degree or higher AND (4) four years of healthcare or medical coding experience in a private, public, government or military environment.

OR

High School Diploma/GED AND (8) eight years of healthcare or medical coding experience in a private, public, government or military environment.

Additional qualifications that could help you succeed even further in this role include:

• Registered Nurse (RN).
• Experience in health information systems or medical billing.
• Any of the following: CCS-H, CCS-P, CPC, CPC-P, COC, CCA, RHIT, RHIA Certified, or a strong working knowledge of ICD-10, CPT & HCPCS coding practices.
• Experience supporting, using, or implementing an HIS system – especially for coding, compliance, billing, or insurance claim adjudication.
• Understanding of medical terminology, procedures & diagnoses.
• Knowledge of the common disease processes, common treatments, and diagnostic tests. Medical coding, billing, or auditing background – especially hospital outpatient.
• Knowledge of medical insurance payment policies or processes.
• Strong organization skills; must be able to meet frequent short-term deadlines. Ability to work independently and collaboratively with team members.
• Strong computer & data analysis skills (e.g. MS Office, Excel, use of databases, or helping design or troubleshoot software solutions – especially related to medical payments or compliance).
• Great reading comprehension with ability to interpret complex regulatory documents and extract key concepts.

Work location: Remote-United States

Travel: May include up to 10% [domestic/international]

Relocation Assistance: Not authorized

Must be legally authorized to work in the country of employment without sponsorship for employment visa status (e.g., H1B status).

Supporting Your Well-being

Solventum offers many programs to help you live your best life – both physically and financially. To ensure competitive pay and benefits, Solventum regularly benchmarks with other companies that are comparable in size and scope.

Applicable to US Applicants Only: The expected compensation range for this position is $106,331 - $129,960, which includes base pay plus variable incentive pay, if eligible. This range represents a good faith estimate for this position. The specific compensation offered to a candidate may vary based on factors including, but not limited to, the candidate’s relevant knowledge, training, skills, work location, and/or experience. In addition, this position may be eligible for a range of benefits (e.g., Medical, Dental & Vision, Health Savings Accounts, Health Care & Dependent Care Flexible Spending Accounts, Disability Benefits, Life Insurance, Voluntary Benefits, Paid Absences and Retirement Benefits, etc.). Additional information is available at: Total Rewards.

Responsibilities of this position include that corporate policies, procedures, and security standards are complied with while performing assigned duties.

Solventum is committed to maintaining the highest standards of integrity and professionalism in our recruitment process. Applicants must remain alert to fraudulent job postings and recruitment schemes that falsely claim to represent Solventum and seek to exploit job seekers.

Please note that all email communications from Solventum regarding job opportunities with the company will be from an email with a domain of @solventum.com. Be wary of unsolicited emails or messages regarding Solventum job opportunities from emails with other email domains.

Please note, Solventum does not expect candidates in this position to perform work in the unincorporated areas of Los Angeles County. Solventum is an equal opportunity employer. Solventum will not discriminate against any applicant for employment on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or veteran status.

Please note: your application may not be considered if you do not provide your education and work history, either by: 1) uploading a resume, or 2) entering the information into the application fields directly.

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