Medicaid Content Analyst

Job Summary

Focused on enhancing Medicaid policies, the full-time salaried Medicaid Content Analyst will manage the research, quality assurance, and analysis of medical policies while collaborating with client teams and mentoring new staff in a remote environment.

Key responsibilities

• Provide coding and industry expertise to create and maintain clinical coding edits
• Write business logic for new rules and enhancements by translating industry references into policy
• Review and update medical policies to ensure an accurate and current policy library

Required qualifications

• Active professional license as a Registered Nurse (BSN preferred), Pharmacist (BSPharm or PharmD), or a Bachelor's degree in a healthcare-related field
• Professional certification (RHIA, RHIT, CPC, CPC-H, CPC-P, or CCS-P) preferred or willingness to obtain within one year
• Minimum of 5 years of experience in a clinical setting or 6 years of clinical coding experience, preferably in a payer setting
• Minimum of 3 years of experience in internet-based research related to coding systems (CPT, HCPCS, ICD, or NDC)
• Knowledge of Medicaid guidelines and familiarity with claims payment methodologies and medical policy rules