Medicare Business Analyst

Job Summary

Serving as a strategic bridge between regulatory requirements and automated execution, the remote Business Analyst, Clinical & Reimbursement Policy will manage the end-to-end lifecycle of clinical and reimbursement policies, ensuring compliance with Medicare guidelines while enhancing policy oversight through vendor management and AI initiatives.

Key responsibilities

• Own the development and maintenance of clinical and reimbursement policies to ensure alignment with CMS regulations
• Act as the Subject Matter Expert on Medicare guidelines, interpreting and operationalizing NCDs and LCDs
• Manage external vendor performance to ensure policy monitoring accuracy and compliance

Required qualifications

• 5+ years of experience in healthcare claims, configuration, or reimbursement policy, with a focus on Medicare Advantage
• Proven expertise in interpreting and operationalizing complex clinical policies, NCDs, and LCDs
• Experience managing vendor relationships at a strategic level
• Familiarity with enterprise claims engines and their impact on adjudication accuracy
• Preferred coding certifications such as CPC, CCS, COC, or CIC