Claims Policy Analyst with CCS Certification

Job Summary

Evaluating and interpreting Payment Integrity policies, the full-time remote Claims Policy Analyst with CCS Certification will analyze federal and state regulations, provide feedback on operational impacts, and collaborate with various teams to ensure accurate claims adjudication.

Key responsibilities

• Review federal and state regulatory changes to determine their applicability to claims processing
• Interpret contractual provisions to ensure correct implementation of benefit and payment logic within claims workflows
• Collaborate with Claims and Configuration Operations to validate rule interpretations and ensure accurate adjudication outcomes

Required qualifications

• High School Diploma or GED equivalent required
• 3+ years of experience in health insurance, claims operations, payment integrity, auditing, or a related discipline required
• CCS-Certified Coding Specialist, RHIT - Registered Health Information Technician, CPC - Certified Professional Coder, or equivalent certification required
• Benefit configuration experience preferred