Medical Policy Analyst

Position: Medical Policy Analyst
Location: Reston, Virginia (Remote)
Duration: 12 months
Note: Must be local to the DMV region (District of Columbia, Maryland, and Virginia).

Job Overview:
We are seeking an experienced Medical Policy Analyst to join our team. This role requires in-depth research, policy development, and coordination of medical policies in alignment with legislative mandates, corporate philosophy, and accepted standards of medical practice. The ideal candidate will have a strong background in nursing, with the ability to write and manage medical policies for various healthcare services.

Key Responsibilities:

• Conduct thorough research on potential and existing medical policies, evaluating peer-reviewed articles and other literature for inclusion.
• Write evidence-based medical policies, including operating procedures, ensuring they align with legal mandates, new technology assessments, and corporate goals.
• Coordinate the distribution and dissemination of medical policies across departments, maintaining the Medical Policy Reference Manual (MPRM).
• Respond to internal business units with written clarifications on existing policies, emerging studies, trends, and other medical policy guidelines.
• Ensure policies are accurate and consistent across all lines of business.
• Maintain and update the MPRM and manage inventory related to medical policy content.
• Work with cross-functional teams to integrate medical policies and procedures in alignment with organizational goals.

Qualifications:

• 10 years of experience in medical policy analysis or a related healthcare field.
• RN - Registered Nurse (State Licensure and/or Compact State Licensure) is REQUIRED.
• Strong research, coordination, and organizational skills.
• Knowledge of healthcare legislation, mandates, and state laws for accurate policy writing.
• Proficiency in tools such as Excel, SharePoint, Haze, MCG, and Encoder Pro.
• Strong written and verbal communication skills to present policies to internal clients.
• Coding background (CCS or CPC) is preferred, but not mandatory.
• Ability to work independently and manage multiple priorities.
• Program management experience is a plus.

Preferred Qualifications:

• Bachelor’s or Master’s degree in Nursing or related healthcare discipline.
• Coursework in technical writing and statistics.

Knowledge, Skills, and Abilities (KSAs):

• Ability to analyze facts and make timely, sound decisions.
• Strong teamwork and mentoring skills, with a willingness to share knowledge.
• In-depth understanding of medical insurance, managed care principles, and coding systems such as CPT and ICD-10.
• Ability to evaluate medical support operations, business practices, and evidence-based guidelines.

43882

Job Types: Full-time, Contract

Pay: $38.00 - $42.00 per hour

Expected hours: 40 per week

Schedule:

• 8 hour shift

Experience:

• Research: 1 year (Preferred)

Work Location: Remote

Salary : $38 - $42