Responsibilities

• Serve as the primary Subject Matter Expert (SME) on clinical and reimbursement policies related to Medicare.
• Translate complex Medicare guidelines, including National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), into actionable logic for the organization.
• Oversee the end-to-end lifecycle of clinical and reimbursement policies, ensuring they are accurately interpreted and regularly updated.
• Collaborate with internal teams to ensure seamless integration of policies into the claims environment.
• Engage with external vendors to enhance policy oversight and ensure compliance with regulatory requirements.
• Utilize data-driven insights and technology to improve policy execution and member experience.
• Monitor and assess the impact of regulatory changes on policies and recommend necessary adjustments.
• Prepare reports and presentations to communicate policy changes and their implications to stakeholders.

Requirements

• Bachelor’s degree in a relevant field; a Master’s degree is preferred.
• Minimum of 3 years of experience in healthcare policy analysis, specifically in Medicare or similar regulatory environments.
• Strong understanding of clinical and reimbursement policies and their implications on claims processing.
• Excellent analytical skills with the ability to interpret complex regulations and translate them into clear, actionable policies.
• Proficient in data analysis tools and methodologies; experience with relevant software is a plus.
• Exceptional communication skills, both verbal and written, with the ability to present complex information clearly to diverse audiences.
• Experience in vendor management and collaboration with external partners.
• Detail-oriented with a strong commitment to accuracy and compliance.

Benefits

• Competitive salary and performance-based bonuses.
• Comprehensive health insurance, including medical, dental, and vision plans.
• Generous paid time off and holiday schedule to promote work-life balance.
• Retirement savings plan with employer matching contributions.
• Access to professional development programs and continuing education opportunities.
• Dynamic and collaborative work environment focused on innovation and improvement.
• Opportunity to make a significant impact on the healthcare experience of our members.