Medical Policy Analyst
NJM Insurance Group
full-time
Posted on:
Location Type: Remote
Location: New Jersey • United States
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Salary
💰 $79,100 - $105,945 per year
About the role
- Provide timely and accurate responses to inquiries from the claim policy teams
- Prepares cases for Medical Director Review and or outside consultant review
- Responsible for processing pends for which the Medical Policy Inquiry Resolution team has authority
- Identifies opportunities for development of or revisions to Horizon Medical Policy based on case review
- Responsible for managing inventory assigned, documenting production in RMRS
- Stays abreast of all mandates, policy changes, workflow changes impacting outcomes
- Performs special projects as assigned by management
Requirements
- High School Diploma/GED required
- Bachelor degree preferred or relevant experience in lieu of degree
- A minimum of 2 years clinical experience
- 3 years experience in the health care delivery system/industry
- Active Unrestricted RN License Required; NJ License Preferred
- Prefer Certified Professional Coder credentials
Benefits
- Comprehensive health benefits (Medical/Dental/Vision)
- Retirement Plans
- Generous PTO
- Incentive Plans
- Wellness Programs
- Paid Volunteer Time Off
- Tuition Reimbursement
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical experiencecase reviewmedical policy developmentinventory managementdocumentation
Soft Skills
timely responseaccuracycommunicationorganizational skills
Certifications
Active Unrestricted RN LicenseCertified Professional Coder