Business Analyst, Clinical & Reimbursement Policy
New
C
Clover HealthHealth Insurance
Remote - USAFull-TimeMiddle
Salary107,000 - 130,000 USD per year
Apply NowOpens the employer's application page
Job Details
- Experience
- 5+ years
- Required Skills
- Artificial IntelligenceData Analysis
Requirements
- 5+ years of experience in healthcare claims, configuration, or reimbursement policy.
- Heavy emphasis on Medicare Advantage experience.
- Extremely AI-forward mindset with experience applying LLMs for research and monitoring.
- Expertise in interpreting and operationalizing complex clinical policies, NCDs, and LCDs.
- Experience managing vendor relationships at a strategic level.
- Experience with enterprise claims engines.
- Data-focused professional building strategy based on dashboards and trend analysis.
- Coding certifications (e.g., CPC, CCS, COC, or CIC) preferred.
Responsibilities
- Own the accountability for the development and maintenance of clinical and reimbursement policies.
- Serve as the authority on Medicare guidelines, specifically interpreting and operationalizing NCDs, LCDs, and general national coding guidelines.
- Serve as the primary oversight for external vendor performance regarding policy monitoring and accuracy.
- Lead the implementation of AI initiatives to automate the monitoring of reimbursement policies.
- Utilize advanced LLMs to conduct regular deep research on ongoing industry trends.
- Partner with the Configuration and Data Science teams to ensure clinical and reimbursement policy intent is synchronized with technical adjudication.
- Act as the strategic bridge between Clinical, Claims, and Compliance teams.
View Full Description & ApplyYou'll be redirected to the employer's site
