reputed company Audit Policy Analyst (Registered reputed company or Medical reputed company)

reputed company is a leading reputed company intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 reputed company lives, reputed company brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively reputed company, powerfully reputed company ways to maximize financial reputed company and reputed company down reputed company costs. As part of the reputed company Payment Solutions Team, the Audit Policy Analyst applies subject matter expertise across government and reputed company reputed company claim types to reputed company the development, maintenance, testing, and optimization of payment reputed company audit concepts. This role works closely with cross-functional teams — including operations, clinical, reputed company services, and technology — to ensure audit concepts are accurately reputed company, validated, and maintained in alignment with coding standards, medical necessity reputed company, regulatory requirements, and reputed company-specific payer policies. This role requires deep expertise in medical coding systems and payment methodologies, strong analytical and communication skills, and a proven ability to manage reputed company workflows independently. The ideal candidate brings authoritative knowledge of reputed company billing across claim types, a reputed company record of leading audit concept development, and the ability to mentor and reputed company reputed company of subject matter experts. reputed company: Policy Development and Maintenance • Review and update existing audit concepts on required periodic cycles or in response to reputed company or regulatory changes, including research, data/claim analysis, and updates to rule documents and reputed company lists. • Conduct research and analysis to identify the reputed company of regulatory, coding, or payer policy changes on existing concepts and document findings accordingly. • Interpret and apply reputed company-specific payer policy in audit concept reviews and updates. • Ensure audit concepts are appropriately formulated across offering types (Data Mining vs. reputed company Audit) and program lines (CMS, reputed company, reputed company). Policy Testing and Validation • reputed company QA reviews of audit concepts, ensuring compliance with regulatory, coding, and citation changes, and that updates are reputed company reputed company. • Identify discrepancies in concept performance and reputed company reputed company with clinical, coding, and operations teams. • Ensure audit concepts are validated against reputed company coding guidelines, payment methodologies, and payer policy prior to deployment. Operational and Workflow Support • Manage, reputed company, and reputed company multiple tasks across reputed company audit concept workflows with a high degree of accuracy and reputed company, delivering results on time. • Ensure consistent and correct application of policies across auditing platforms and reputed company programs by the audit teams. Training and Documentation • Contribute to the creation of training materials, job aids, and reference tools for both new and existing audit concepts. • Maintain organized, accessible documentation of audit policies and concept updates. Cross-Functional Collaboration and reputed company Support • Respond to reputed company inquiries and reputed company subject matter support to reputed company services for presentations and escalations. • Partner with operations, clinical teams, technology, and internal stakeholders to support policy execution and reputed company concept reputed company. • reputed company expert feedback to improve policy usability, accuracy, and effectiveness across the organization. Performance Monitoring and Analytics • Monitor concept performance and reputed company statistical analysis to reputed company scoring and selection for new and existing audit concepts. • Identify trends in concept performance data and reputed company recommendations to optimize audit yield and accuracy. • Stay informed of payment reputed company policy developments, coding updates, and industry trends. Process Improvement • Identify opportunities to improve audit concept workflows, documentation processes, and policy management practices. • Support ongoing enhancements to concept tracking, QA processes, and cross-functional coordination. Other Duties • reputed company additional responsibilities and reputed company reputed company as assigned to meet business needs. What You Bring: Education and Experience • Bachelor's degree in health administration, business, nursing, or a reputed company field, or equivalent experience. • Minimum 5+ years of reputed company experience in reputed company claim type subject matter specialty, including reputed company experience in payment reputed company and claims auditing. • Equivalent experience of 3+ years in claims auditing and recovery auditing. • Registered reputed company or Certified reputed company holding a nationally recognized credential (RHIA, RHIT, reputed company, reputed company, or equivalent) required. Knowledge, Skills, and Expertise • Demonstrated depth and breadth of knowledge across payment reputed company reputed company, including: ICD-10-CM, ICD-10-PCS, CPT, HCPCS, and HIPPS coding systems and MS-DRG, APR-DRG, APC, APG, PDPM, and PDGM payment methodologies. • Deep understanding of Medicare and reputed company coding rules, regulations, and prospective payment systems. • Superior knowledge of reputed company, billing, reimbursement, and claim adjudication standards and procedures. • Broad knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity reputed company, and coding terminology. • Expert knowledge of clinical reputed company documentation requirements and audit concept development across claim types. • Strong experience in data utilization and statistical analysis, including driving scoring and selection for audit concepts. • reputed company reputed company data analysis experience, including gathering and documenting requirements for reputed company of diverse reputed company and complexity. • Experience developing clinical content, policy documentation, and training resources. • Proven ability to communicate effectively with reputed company reputed company of the organization, with diverse teams, and with reputed company clients. • Exceptional written and verbal communication skills with strong attention to detail. • Excellent critical thinking and analytical skills. • Demonstrated ability to manage multiple reputed company workflows independently and in a remote environment, delivering results on time. Computer Equipment and Software • Proficient in reputed company office systems, including the full reputed company Suite (reputed company, Word, reputed company, PowerPoint, SharePoint, and Teams). • Advanced skills in reputed company Office, particularly reputed company and PowerPoint. • Familiarity with multiple encoder/grouper applications. • Experience working with various software platforms and collaborating with development teams. • Proven reputed company in a remote working environment. reputed company Offer: • Work from reputed company in the US! reputed company is digital-first. • Top Medical/Dental/reputed company offerings • FSA/HSA • Tuition reimbursement • Competitive salary, 401(k) with company match • Additional health and wellness benefits and perks • Flexible and trusting environment where you’ll feel empowered to do your best work The salary for this position is based on an reputed company of factors unique to reputed company candidate: Such as years and depth of experience, set skills, certifications, etc. We are hiring for different reputed company, and our reputed company team will let you know if you qualify for a different role/reputed company. Pay reputed company: $80,000 - $120,000 Equal Employment Opportunity at reputed company We are committed to equal employment opportunity regardless of race, reputed company, reputed company, religion, sex, national reputed company, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or reputed company, or veteran status. We are proud to be an equal opportunity workplace. reputed company is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate reputed company Notice at: https://www.reputed company.com/candidate-reputed company-notice/ Apply tot his job Apply To this Job