At Experian Health, our employees have the opportunity to shape more than products – they shape the future of U.S. healthcare. Experian Health is a pioneer for innovations leading the way in revenue cycle management, identity management, patient engagement, and care management for hospitals, physician groups, labs, pharmacies and other risk-bearing entities. Our success relies on people who are given the freedom to imagine new frontiers in the rapidly changing healthcare space and push the boundaries of innovation. Help us realize our vision of applying data for good and changing the healthcare landscape for the better – for all of us.

Our mission is to use data driven insights to simplify healthcare for all. Simply put, we want to make the healthcare system work better for us as consumers and for those who work in healthcare. Our ONE Experian Health culture is the centerpiece of making this happen. Our aspiration is to bring people together who are driven by purpose and want to make a difference. We strive to have a diverse group of people and minds who are:

• OPEN: Have a growth mindset and collaborate often with others to make things happen
• NIMBLE: Always embracing change and pushing the envelope on innovative ways to solve problems
• EFFECTIVE: Accountable to themselves and to others

THIS ROLE IS 100% REMOTE (NOT HYBRID) - WORK FROM ANYWHERE IN THE US!

Under general direction, the Sr. Managed Care Policy Analyst is responsible for the accurate representation of medical rules/edits from any payer source. Additionally, the Managed Care Policy Analyst, Sr. is responsible for building, utilizing, and understanding Medicare tables, Claims Transaction Engine (CTE) tables and interacting with clients regarding Compliance Support Issues identified.

Job Responsibilities:

• Identify necessary and potential changes to existing medical rules through
• review of current and historically available hardcopy medical policies, transmittals and bulletins. This includes but is not limited to revision and retirement of existing policies and the addition of new policies.
• Extracts information from resources and translates information needed to form appropriate logic for rules. Also responsible for payer table build, documentation and Quality Assurance review. Completes CTE table builds, review and complete integrity checks for multiple software products as these edits are used, or modified, for varying levels of ICD-10-CM review and Medical Necessity checking.
• Completes reviews of medical policies and publications and its integration into the required database on a timely basis. Identifies patterns of improper coding or errors in policies and publications and is able to resolve and recommend alternate codes, or code representation is appropriate table(s) (Diagnosis, CPT/HCPCS, CCI_Edits)
• Prepares documentation and reviews as needed with the Director. Reviews forwarded Technical Support information/documentation for completeness and accuracy. Composes responses and discusses with clients if necessary.
• Maintains all medical rules editorials in the appropriate MS Access database utilizing
• programmatic tools Ability to research and analyze data.
• Responsible for timely and accurate research of resources that update critical information on a scheduled basis. Stays abreast of current coding issues.

• 3+ years experience with and knowledge of Current Procedural Terminology (CPT) Coding, and International Classification of Disease (ICD-10) Codes required. Ability to understand and retain coding information, and transfer that information into completed product data.
• An Associate’s or Bachelor’s degree in the Life Sciences or Accredited Record Technician’s certification (ART) or Certified Procedural Coder certificate (CPC) or a combination of training, education and experience that is equivalent to the standards listed and that provides the required knowledge and abilities
• Ability to maintain effective working relationships is essential
• Knowledge of Medical Terminology
• Knowledge of anatomy and physiology
• Knowledge of Medicare reimbursement guidelines
• Standard English grammar/usage and proper telephone etiquette
• Must be able to write in a clear and understandable manner
• Prior experience in developing medical policy edits desired
• Must be able to exercise independent judgement
• Previous Healthcare experience desired
• Prior experience in developing medical policy edits desired
• Must have high standards with extreme attention detail
• Previous experience as an outpatient Medical Coder is a plus
• Experience with Microsoft Access a plus

Experian is an Equal Opportunity Employer. Anyone needing accommodation to complete the interview process should notify the talent acquisition partner. The word "Experian" is a registered trademark in the EU and other countries and is owned by Experian Ltd. and/or its associated companies.
EOE including Disability/Veterans.

Our compensation reflects the cost of labor across several U.S. geographic markets. The base pay range for this position is listed above. Within this range, individual pay is determined by work location and additional factors such as job-related skills, experience and education. This position is also eligible for a variable pay opportunity and a comprehensive benefits package which includes health, life and disability insurance, generous paid time off including paid parental and family care leave, an employee stock purchase plan and a 401(k) plan with a company match.

Experian is proud to be an Equal Opportunity and Affirmative Action employer. Our goal is to create a thriving, inclusive and diverse team where people love their work and love working together. We believe that diversity, equity and inclusion is essential to our purpose of creating a better tomorrow. We value the uniqueness of every individual and want you to bring your whole, authentic self to work. For us, this is The Power of YOU and and it reflects what we believe. See our DEI work in action!

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