Clinical Policy Review Analyst | MNC | Hyderabad | WFO | V3 Staffing

3.0 - 8.0 years

7 - 7 Lacs

hyderabad

Work from Office

Greetings of the day ! Our reputed MNC Client is hiring for Clinical Policy Review Analyst role: Job Description: As a Clinical Policy Review Analyst, you will be responsible for providing in-depth clinical coding analysis of professional and facility claims, maintaining up-to-date clinical guidelines, and ensuring compliance with industry standards. Key Responsibilities: - Provide clinical coding analysis of professional and facility claims routed to the Clinical Policy Review queue - Maintain current industry knowledge of claim edit references, including AMA, CMS, NCCI, and other relevant guidelines - Conduct research on coding scenarios and provide data-driven insights and business recommendations - Collaborate with cross-functional teams to identify and resolve edit performance issues - Assist in creating and maintaining job aides and guidelines for review and claims workflow process improvements Requirements: - 3+ years of relevant experience in healthcare payers/claims payment processing - Certified Coder (CCS, CCS-P, or CPC) with a strong understanding of clinical policy interpretation and claims workflow - Knowledge of payer reimbursement policies, state and federal regulations, and applicable industry standards - Excellent analytical, problem-solving, and communication skills - Ability to work independently and collaboratively in a team environment Preferred Qualifications: - Experience with medical records review and NCCI editing - Strong understanding of US healthcare system and federal websites (CMS, FDA, etc.) Warm Regards, Gayatri Kumari Email Id: gayatri@v3staffing.in V3 Staffing Solutions

Posted Date not available

Apply

Start Your Job Search Today

Browse through a variety of job opportunities tailored to your skills and preferences. Filter by location, experience, salary, and more to find your perfect fit.