Research Manager
amps
full-time
Posted on:
Location Type: Office
Location: Alpharetta • United States
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About the role
- Support the expansion and ongoing maintenance of the Medical Policy Content Library in alignment with industry standards and regulatory updates
- Translate industry references, clinical guidelines, and regulatory directives into clear, accurate AMPS medical policies
- Serve as the primary point of contact for the Global Research Team, providing ongoing support, direction, and feedback related to medical policy development
- Provide training, coaching, and mentoring to the Global Research Team to ensure consistent quality and performance
- Participate in and support User Acceptance Testing (UAT), including the development of test scenarios to validate new and updated policies prior to production release
- Oversee the Client Inquiry process to ensure responses are accurate, concise, and delivered in a timely manner
- Conduct data analysis to identify billing trends and patterns that may inform new policy development or highlight potential risks to existing policies
- Identify opportunities for system enhancements that support policy expansion, accuracy, and efficiency
- Support continuous process improvement initiatives to promote accuracy, consistency, and repeatable outcomes
- Build and maintain trust-based, professional relationships with internal stakeholders and, when required, external business partners
- Apply project management principles to initiate, develop, and manage medical payment policies
- Proactively contribute expertise and insights to add value to departmental and client initiatives.
Requirements
- Bachelor’s degree is preferred, or equivalent combination of education and experience
- Minimum of 3 years of experience with CPT, ICD-10, and HCPCS coding
- Minimum of 2 years of experience in claims adjudication, medical or payment policy, utilization review, or related roles within a managed care or healthcare insurance environment; familiarity with claims management and billing systems preferred
- Minimum of 2 years of customer service experience in a healthcare-related setting
- Strong research skills with demonstrated knowledge of CMS guidelines, regulatory compliance requirements, and medical payment policy
- Solid understanding of medical terminology
- Proven ability to handle confidential and sensitive information with professionalism and discretion
- Ability to work independently while demonstrating a strong track record of success in collaborative team environments
- Excellent written, verbal, and interpersonal communication skills.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
CPT codingICD-10 codingHCPCS codingclaims adjudicationmedical policy developmentutilization reviewdata analysisproject managementUser Acceptance Testing (UAT)medical terminology
Soft Skills
trainingcoachingmentoringcommunicationcollaborationproblem-solvingrelationship buildingprocess improvementindependenceprofessionalism