Research Policy Analyst

1 day ago

Bengaluru, Karnataka, India beBeeMedicalPolicy Full time ₹ 15,50,118 - ₹ 20,29,847
Job Description

We seek a highly skilled professional to contribute to the development and enhancement of medical policy content. This role involves researching new policies, ensuring quality assurance, and identifying opportunities to expand policy libraries.


Key Responsibilities

- Develop and implement concepts to detect incorrect healthcare payments through semi-automated claims validation
- Design and maintain semi-automated claims review frameworks and algorithms
- Manually review claims, identify incorrect coding or billing, and flag those claims
- Support managing 1-2 medical reimbursement payment policies end-to-end for analysts, and 2-3 policies for managers and above
- Analyze medical reimbursement methodologies, including policy rules and edits
- Synthesize complex clinical and coding guidelines into actionable business logic
- Ensure compliance and update rules according to the latest industry standards
- Leverage expertise in medical coding, healthcare claims processing, and industry standards to support the development of clinical coding policies and edits
- Operate independently as an individual contributor


Requirements

- Strong domain expertise in semi-automated claims review
- Solid understanding of medical coding and billing methodologies and guidelines, including CPT, ICD, LCD/NCD, PTP, NCCI, edits, modifiers, Medicare Physician fee schedule, and coding conventions
- Proficiency in data collection, analysis, and deriving actionable insights from CMS medical policies, Medicaid Provider Manuals, and other Medical publications
- Translate industry references into actionable business logic to support new rules and policy enhancements
- Strong understanding of claim forms like UB-04/CMS 1450 and CMS 1500
- Collaborate effectively across teams while managing multiple priorities
- Ability to thrive in a fast-paced, dynamic environment with minimal supervision
- Demonstrated mindset for continuous learning and improvement and apply insights to policy development, refinement, and maintenance
- Strong stakeholder management, interpersonal, and leadership skills
- Solution-focused, motivated, entrepreneurial spirit with a strong sense of ownership
- Clear and effective communication
- Strong attention to accuracy and detail in all deliverables

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