Posted:None|
Platform:
Work from Office
Full Time
Greetings of the day !
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.
- 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
- 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
- Strong understanding of US healthcare system and federal websites (CMS, FDA, etc.)
Warm Regards,
Gayatri Kumari
V3 Staffing Solutions
V3 Staffing
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