Remote Medical Policy Implementation Specialist

geisinger; United States; Remote; USD 60,000 - 90,000; Full time

Job summary

Geisinger is seeking a Medical Policy Analyst to support policy development and clinical guideline work. The role audits and analyzes medical claims, investigates coding issues, and advises on coverage based on current policies and industry standards.

Responsibilities include research, data analysis, and collaboration with staff to ensure accurate benefits configuration and compliant claim processing. A background in CPT coding and claims systems is preferred.

Qualifications

• Experience with CPT coding, Medical Claims, Benefit Configuration preferred.
• Minimum 2 years relevant experience, required.
• High school diploma or GED required.

Responsibilities

• Experience with CPT coding, Medical Claims, Benefit Configuration preferred
• Directs benefits systems analysts to ensure correct configuration by line of business
• Research and retrospective review of medical claims for policy compliance
• Review medical records to validate services billed with codes
• Research reimbursement, medical record documentation, utilization and coding
• Audit claims and identify opportunities for process improvement

Skills

CPT coding

Medical claims

Data analysis

Communication

Leadership

Education

High School Diploma or GED

Tools

Facets workflow

Job description

Geisinger is seeking a Medical Policy Analyst to support policy development and clinical guideline work. The role audits and analyzes medical claims, investigates coding issues, and advises on coverage based on current policies and industry standards.

Responsibilities include research, data analysis, and collaboration with staff to ensure accurate benefits configuration and compliant claim processing. A background in CPT coding and claims systems is preferred.