Reimbursement Policy Analyst

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 leading the development, planning, and implementation of new or current medical coding reimbursement policies leveraging medical coding certification and billing reconciliation experience. Conducts financial impact analysis based on claim utilization based on changes to reimbursement policy, MCO notices, Bulletins, and HHSC / TMPPM guidelines. Recommends optimal system configuration based on medical coding billing / reimbursement experience. Leads medical policy meetings and participates in policy discussion by providing comments and recommendations orally or in writing.

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Job Duties & Responsibilities
- Researches, analyzes, and creates Medicaid reimbursement policy leveraging medical coding certification and billing experience that includes analyzing the regulatory guidelines and converting to creation of medical policy and financial impact analysis
- Research, develop, and implement a coordinated approach to ensure regulatory adherence for the department, through participation in Medical Policy, Reimbursement Committee, and other workgroups as needed, provides support for the facilitation of the process and/or system changes
- Research & analyze medical policy and procedures, assessing risks and its impact to dependent areas and providing system optimization recommendation
- Analyze and evaluate complex federal and state legislation and creation of financial impact analysis
- Lead and project manage collaborations within and with other departments to ensure compliance standards are met
- Creation and presentation to various levels of organization (peers, leadership, IT, C Suite) through strong written and oral communication skills (written, verbal, non-verbal)
- Create technical & non-technical documentation
- Project management approach in execution of work efforts - planning, evaluation, and implementation.
- Facilitate meetings and maintain working relationships with staff or program stakeholders
- Exercise creative problem-solving techniques in a highly complex environment
- Work cooperatively as a team member in a fast-paced, deadline-orientated environment
- Work independently and perform work with a high degree of attention to detail
- Use of Microsoft Office products and various reporting tools in completion of daily work functions
- Performs and plans configuration changes for coding, contracts, benefits, fee schedules and claim editing rules as needed

Knowledge and Skills

- Must have demonstrated experience creating a reimbursement policy / operating guideline from regulation
- Must have proficiency in excel (data extraction, pivot, vlookup, sum, import / export data into / out of excel)
- Able to demonstrate knowledge of Medicaid, regulatory sites referenced, and examples of how use and reference
- Must be able to give code level examples of code analysis and remediation

Skills & Requirements
•    Required bachelor's degree and preferred master's degree in business, Health Care Administration, Public Health, Nursing, MIS or an IS related field
•    2 years’ experience in Experience in a managed care organization or healthcare organization and preferred 5 years Master Proficiency in SQL, MS access, and data analysis within an MCO or healthcare organization
 

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