Medical Policy Analyst

Role Overview

• Provide timely and accurate responses to inquiries from the claim policy teams
• Prepares cases for Medical Director Review and or outside consultant review
• Responsible for processing pends for which the Medical Policy Inquiry Resolution team has authority
• Identifies opportunities for development of or revisions to Horizon Medical Policy based on case review
• Responsible for managing inventory assigned, documenting production in RMRS
• Stays abreast of all mandates, policy changes, workflow changes impacting outcomes
• Performs special projects as assigned by management

Requirements

• High School Diploma/GED required
• Bachelor degree preferred or relevant experience in lieu of degree
• A minimum of 2 years clinical experience
• 3 years experience in the health care delivery system/industry
• Active Unrestricted RN License Required; NJ License Preferred
• Prefer Certified Professional Coder credentials

Benefits

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement