Clinical Policy Analyst

As a Clinical Policy Analyst, you will provide guidance and analysis related to all aspects of service management associated with the CareCentrix portfolio of products. You will perform impact and root cause analysis and maintenance of management pathways related to configuration requirements including but not limited to Opportunity Matrix, Xpedite process with a focus on impact to service management among CareCentrix products and front end activities to support our business partners. Additionally, you will need to conduct research related to industry standards published by governing bodies and providing guidance and documentation to business and system initiatives.

In this Job, you will:

• Create, implement, and maintain tracking, trending, and reporting tools.
• Oversee, maintane and validate service management pathways, including but not limited to CMS updates such as ICD10, HCPC, Xpedite process, Grouper updates, opportunity matrix, and prior authorization tool.
• Participate in Drug Pipeline meetings, work with clinical team to support exit process and alignment of drug library with industry standard.
• Support quarterly CMS Updates, by following and downloading the posted CMS file, and managing the end to end service management process.
• Perform ongoing independent research related to business change impact analysis with a focus on service management of CareCentrix internal rules to allow for authorizations and proper billing, as well as potential internal and external stakeholder process changes which may be required.
• Maintain CareCentrix standard system processes of artifacts affected by changes implemented by governing bodies, new services to market, product enhancement or tailoring efforts or in support of new product development and develop education and communication materials for cross-functional audiences.
• Establish and maintain cross-functional relationships to address coding and associated rule issues facing the organization
• Serve as resource and DME subject matter expert to other staff.
• Must perform other duties as required or assigned

You should get in touch if you have: 

• BA/BS degree preferred or 3 + years of proficiency in durable medical equipment service experience including a working knowledge of industry guidelines and resources.
• Medical Assistant experience preferred.
• Experience in medical coding, billing, and claim requirements preferred.
• Proficient in MS Office suite with advanced skills in Excel, and SQL. {Formulas, equations, linking excel to SharePoint}
• Tableau or Power BI knowledge desired.

What we offer:

• Salary Range - $60000 - $65000 / year plus corporate bonus incentives
• Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match.
• Bonus Incentives, Generous PTO, 401K Savings Plan, Paid Parental Leave, free on-demand Virtual Fitness Training and more.
• Advancement Opportunities, professional skills training, and tuition /exam reimbursement.
• Walgreens Discount - receive up to 25% off eligible items.
• Great culture with a sense of community.

CareCentrix maintains a drug-free workplace.

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We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.

CareCentrix accepts applications on an ongoing basis until a candidate is identified.