New Jersey Licensed Medical Policy Analyst

Job Summary

A company is looking for a Medical Policy Analyst responsible for medical policy determination and analysis of claims.

Key Responsibilities

• Provide timely and accurate responses to inquiries from claim policy teams regarding medical reviews and appeals
• Prepare cases for Medical Director and outside consultant review as necessary
• Identify opportunities for policy development or revisions based on case reviews and manage assigned inventory

Required Qualifications

• High School Diploma/GED required; Bachelor's degree preferred or relevant experience in lieu of degree
• Minimum of 2 years clinical experience and 3 years in the health care delivery system/industry
• Active Unrestricted RN License required; NJ License preferred
• Prefer Certified Professional Coder credentials