Medical Policy Analyst (Part-Time - 32 hrs weekly)
$70,500–$94,395 year
RemoteNewark, New Jersey, United States
Job Summary
Review post-service medical necessity and appealed claims for compliance with medical policies, plan benefits, and regulatory requirements. Perform coding reviews and prepare cases for Medical Director or outside consultant response. Provide timely responses to inquiries and collaborate with claim policy teams on pending reviews. Document production, manage assigned inventory, and communicate opportunities for medical policy revisions. Stay current on mandates, policy changes, and workflow updates impacting review outcomes. Requires high school diploma, three years clinical nursing experience, and effective communication skills. Part-time, 32 hours weekly.
Required Qualifications
- High School Diploma/GED
- Minimum of 3 years' clinical nursing experience
- Effective verbal and written communication skills
- Ability to work well within a team
- Professional and ethical business practices
- Adherence to company standards
- Commitment to personal and professional development
- Time management skills
- Ability to manage multiple priorities or tasks
- Ability to deliver timely and accurate work products with a customer service focus
- Ability to respond with a sense of urgency as required
- Ability to work in a production focused environment
- Sound judgment
- Strong problem-solving skills
- Ability to ask probing questions and obtain thorough and relevant information
- Knowledge and understanding of the laws, regulations and policies that pertain to the organization's business
- Ability to conform to laws, regulations and policies in carrying out the accountabilities of the job
- Must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
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