Senior Managed Care Policy Analyst

Experian

. Manage the accurate representation of medical rules/edits from any source .

Posted 4/25/2026full-timeRemote • 🇺🇸 United StatesSenior💰 $57,111 - $98,993 per yearWebsite

About the role

Key responsibilities & impact

Manage the accurate representation of medical rules/edits from any source
Build and use all tables and work with clients regarding Technical Support Issues identified
Review and make recommendations regarding Level I and Senior coding, placement, and logic
Responsible for assisting with building tables associated with new products or technology
Responsible for the release and review of content into production for client use
Make recommendations and assist with data/tables for new products
Report to the Senior Director, Compliance Data
Identify necessary and potential changes to existing medical rules through review of current and historically available hardcopy medical policies, transmittals and bulletins
Complete Clinical Transaction Engine table builds (used by eCN Medical Necessity and ClaimSource) with completion of integrity checks
Review of edit modification for medical procedures for clear representation varying levels of ICD-10-CM diagnoses
Assign CPT/HCPS codes for PreCertification product table(s)
Participate in review of National NCD's for National policies, assigning appropriate diagnosis and procedural codes
Prepare reports and documents for Director review including coding trends, documentation requirements, related payer changes and concerns
Complete reviews of medical policies and publications and its integration into the required database
Identify patterns of improper coding or errors in policies and publications and can resolve and recommend alternate codes
Maintain all medical rules editorials in the appropriate database using programmatic tools
Analyze data and draw conclusions
Responsible for accurate research of resources that update critical information on a scheduled basis

Requirements

What you’ll need

Associate's or Bachelor's degree in the Life Sciences or Accredited Record Technician's certification (ART) or Certified Procedural Coder certificate (CPC) or outpatient Medical Coder experience or an equivalent combination of training, education and experience
4+ years experience with and knowledge of Current Procedural Terminology (CPT) Coding, and International Classification of Disease (ICD-10) Codes required
Must understand and retain coding information and transfer that information into completed product data
Experience researching and drawing conclusions regarding medical edits
Knowledge of Medicare reimbursement guidelines
Knowledge of Medical Terminology
Knowledge of anatomy and physiology
Standard English grammar/usage and proper telephone communication
Write in a clear and understandable manner
Previous Healthcare experience

Benefits

Comp & perks

Great compensation package and bonus plan
Core benefits including medical, dental, vision, and matching 401K
Flexible work environment, ability to work remote, hybrid or in-office
Flexible time off including volunteer time off, vacation, sick and 12 paid holidays

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

CPT CodingICD-10 CodingClinical Transaction EngineData AnalysisTable BuildingMedical Rules EditingCoding Trends AnalysisIntegrity ChecksMedical Policy ReviewCoding Error Resolution

Soft Skills

CommunicationResearchAttention to DetailProblem SolvingClear WritingInterpersonal SkillsOrganizational SkillsAnalytical ThinkingRecommendation SkillsClient Support

Certifications

Associate's DegreeBachelor's DegreeAccredited Record Technician (ART)Certified Procedural Coder (CPC)