Reimbursement Policy Analyst

Intelligence and National Security Alliance; Bellaire (TX); Remote; USD 60,000 - 100,000; Full time

Job summary

An innovative firm is seeking a Reimbursement Policy Analyst to support and develop strategic health plan programs. This remote role involves creating and analyzing Medicaid reimbursement policies, conducting financial impact analyses, and leading policy discussions. The ideal candidate will leverage their medical coding and billing experience to recommend system configurations and ensure regulatory adherence. Join a dynamic team where your expertise will drive impactful changes in healthcare reimbursement processes, making a significant difference in the industry.

Qualifications

• 2+ years in managed care or healthcare organization; 5 years preferred.
• Experience creating reimbursement policies from regulations.

Responsibilities

• Research and create Medicaid reimbursement policies based on regulations.
• Lead collaborations to ensure compliance standards are met.
• Analyze federal and state legislation for financial impacts.

Skills

Medicaid reimbursement policies

Medical coding certification

Billing reconciliation

Financial impact analysis

Project management

Data analysis

Excel proficiency

SQL proficiency

Education

Bachelor's degree

Master's degree in Business or Healthcare Administration

Tools

Microsoft Office

SQL

MS Access

Job description

We are searching for a Reimbursement Policy Analyst (Remote)—someone who works well in a fast-paced setting. In this position, you will support and develop programs aligned with Health Plan strategic goals through effective and timely leadership in the development, planning, and implementation of new or current medical coding reimbursement policies, leveraging medical coding certification and billing reconciliation experience. You will conduct financial impact analyses based on claim utilization changes related to reimbursement policy updates, MCO notices, Bulletins, and HHSC / TMPPM guidelines. Additionally, you will recommend system configurations based on medical coding, billing, and reimbursement experience. The role involves leading medical policy meetings and participating in policy discussions by providing comments and recommendations orally or in writing.

Job Duties & Responsibilities

1. Research, analyze, and create Medicaid reimbursement policies leveraging medical coding certification and billing experience, including analyzing regulatory guidelines and translating them into medical policies and financial impact assessments.
2. Develop and implement a coordinated approach to ensure regulatory adherence, participating in Medical Policy, Reimbursement Committee, and other workgroups as needed, supporting process and system changes.
3. Research and analyze medical policies and procedures, assess risks, and evaluate their impact on related areas, providing system optimization recommendations.
4. Analyze and evaluate complex federal and state legislation, conducting financial impact analyses.
5. Lead and project manage collaborations within and across departments to ensure compliance standards are met.
6. Create and deliver presentations to various organizational levels (peers, leadership, IT, C Suite) using strong written and oral communication skills.
7. Develop technical and non-technical documentation.
8. Apply project management principles in planning, evaluating, and executing work efforts.
9. Facilitate meetings and maintain working relationships with staff or stakeholders.
10. Exercise creative problem-solving techniques in a highly complex environment.
11. Work cooperatively in a fast-paced, deadline-oriented environment and independently with high attention to detail.
12. Utilize Microsoft Office products and reporting tools to complete daily tasks.
13. Plan and perform configuration changes for coding, contracts, benefits, fee schedules, and claim editing rules as needed.

Knowledge and Skills

• Experience creating reimbursement policies or operating guidelines from regulations.
• Proficiency in Excel (data extraction, pivot tables, VLOOKUP, SUM, data import/export).
• Knowledge of Medicaid, relevant regulatory sites, and how to reference them.
• Ability to provide code-level examples of code analysis and remediation.

Skills & Requirements

• Bachelor's degree required; master's degree in Business, Healthcare Administration, Public Health, Nursing, MIS, or a related field preferred.
• At least 2 years of experience in a managed care or healthcare organization; 5 years preferred.
• Proficiency in SQL, MS Access, and data analysis within an MCO or healthcare setting.