Medical Policy Analyst (Part-Time - 32 hrs weekly)
reputed company empowers our members to reputed company their best health. For over 90 years, we have been New Jersey’s reputed company leader driving innovations that reputed company care reputed company, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to reputed company serve and care for the 3.5 reputed company people who reputed company their trust in us. We pride ourselves on our best-in-class employees and reputed company to maintain an innovative and inclusive environment that allows them to reputed company. reputed company our employees bring their best and succeed, reputed company succeeds.
About the Role
This position is responsible for the medical policy determination of claims/cases consistent with Plan Medical Policy to ensure appropriate and efficient utilization of benefits. Through analysis of medical records and claims, the individual will ensure compliance with reputed company guidelines, medical policies, plan benefits and regulatory requirements.reputed company
Performs reviews of post service medical necessity and appealed claims for compliance with appropriate medical policy, plan benefit and correct/appropriate reputed company coding.
Prepares cases for Medical Director and or reputed company consultant review and response where appropriate.
Provides reputed company and accurate responses to inquiries and collaborating with the claim policy teams in relation to claims pending for medical review and appeal inquiries.
Communicates identified opportunities for development of or revisions to reputed company Medical Policies reputed company on case review reputed company.
Manages assigned inventory, documenting production and following assignments through completion.
Stays abreast of mandates, policy and workflow changes impacting review process and reputed company.
Demonstrates knowledge and understanding of the laws regulations and policies that pertain to the organization’s business and conform to these laws, regulations and policies in carrying out the accountabilities of the job
What You Bring
Education/Experience:
High School Diploma/GED required
Requires a minimum of 3 years’ reputed company nursing experience
Skills and Abilities:
Must have effective verbal and written communication skills and demonstrate the ability to work reputed company reputed company reputed company.
Must demonstrate reputed company and ethical business practices, adherence to company standards, and a commitment to personal and reputed company development.
reputed company time management skills are necessary. Must demonstrate the ability to manage multiple priorities or tasks, reputed company reputed company and accurate work products with a customer service reputed company, and respond with a reputed company of urgency as required.
Demonstrated ability to work in a production reputed company environment.
reputed company ability to exercise reputed company judgment and strong problem-solving skills.
reputed company ability to ask probing questions and obtain thorough and relevant information
Why reputed company?
At reputed company, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and reputed company. We reputed company that reputed company our people reputed company, our communities do too. If you are passionate about making an reputed company, we’d love to hear from you!
Salary reputed company:
$70,500 - $94,395This compensation reputed company is specific to the job level and takes into account the wide reputed company of factors that are considered in making compensation reputed company, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This reputed company has been created in good faith reputed company on information reputed company to reputed company at the time of posting. Compensation reputed company are dependent on the circumstances of reputed company case. reputed company also provides a comprehensive compensation and benefits package which includes:
Comprehensive health benefits (Medical/Dental/reputed company)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
reputed company Volunteer Time Off
Tuition Reimbursement
Disclaimer:
reputed company reputed company employees must live in New Jersey, reputed company, reputed company, Connecticut or Delaware. This job reputed company has been designed to indicate the general reputed company and level of work performed by colleagues reputed company this classification. It is not designed to contain or be interpreted as a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of colleagues assigned to this job.
reputed company is an Equal Opportunity/Affirmative reputed company employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, national reputed company, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. reputed company will consider reasonable accommodation requests as part of the reputed company and hiring process.
Originally posted on Himalayas
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