Coding Business Analyst II - Policy Review
Core
Analyze and interpret coding, reimbursement, and regulatory guidelines to ensure organizational compliance and payment integrity for health insurance claims.
Role type
Business Analyst (Healthcare Claims & Policy)
Builds
Payment policies, reimbursement methodologies, and claims editing logic
Domain
Healthcare / Insurance / Managed Care
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Business process analysis, Claims payment analysis, Regulatory guideline interpretation, Data analysis, User acceptance testing, Requirements gathering, Process improvement, Policy development, Stakeholder coordination, Reporting
Preferred skills
CPC certification, Claims coding appeals experience, Revenue cycle experience, Claims research, Excel (pivot tables, VLOOKUPs), Managed care systems knowledge, Benefits pricing knowledge, Provider reimbursement methodology knowledge, Structured testing experience
Technologies
Excel, Managed care information systems
Responsibilities
Review state-specific and corporate payment policies for compliance and governance, Develop and maintain reimbursement methodologies and claims editing logic, Monitor and track regulatory and policy updates, Support business initiatives through data analysis and UAT, Identify user requirements and improve existing processes, Lead problem-solving and coordination between business units, Formulate and update departmental policies and procedures
Seniority
Mid-level, hands-on IC