Business Analyst, Clinical & Reimbursement Policy
New
United StatesFull-TimeMiddle
Salary107,000 - 130,000 USD per year
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Job Details
- Experience
- 5+ years of experience in healthcare claims, configuration, or reimbursement policy
- Required Skills
- Artificial IntelligenceLLM
Requirements
- 5+ years of experience in healthcare claims, configuration, or reimbursement policy.
- Deep expertise in Medicare Advantage.
- Strong proficiency in interpreting and operationalizing NCDs and LCDs.
- Experience managing vendor relationships at a strategic level.
- Data-focused mindset with experience using dashboards and trend analysis.
- Familiarity with enterprise claims engines and adjudication logic.
- Enthusiasm for applying LLMs (Claude, Gemini, ChatGPT) to operational tasks.
- Coding certifications such as CPC, CCS, COC, or CIC are preferred.
Responsibilities
- Develop and maintain clinical and reimbursement policies aligned with CMS regulations.
- Interpret and operationalize NCDs, LCDs, and national coding guidelines.
- Manage external vendor performance through data-driven reviews.
- Implement AI initiatives using LLMs to automate reimbursement policy monitoring.
- Collaborate with configuration and data science teams to ensure policy intent syncs with technical adjudication.
- Act as a strategic bridge between clinical, claims, and compliance teams.
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