Healthcare Policy Analyst

2 weeks ago

Baltimore, Maryland, United States Blue Cross and Blue Shield Association Full time
Healthcare Policy Analyst - RN (Remote)

Responsibilities & Qualifications

OBJECTIVE:

In partnership with the Medical Director, the Healthcare Policy Analyst will conduct thorough research, assess, analyze, and update healthcare policies and operational procedures to align with the organization's mission, provider agreements, and recognized standards of medical practice.

We seek a qualified professional to work remotely, with occasional visits to designated locations for meetings, training, and other work-related activities.

KEY FUNCTIONS:

  • Conduct comprehensive research on medical subjects outlined in current healthcare policies and operational procedures scheduled for revision based on evolving standards of care. Review peer-reviewed studies and other relevant literature to assess their suitability for clinical guidance and compliance with legislative requirements.
  • Collaborate with the Medical Director to amend evidence-based healthcare policies and operational procedures, ensuring adherence to legislative mandates, contractual obligations, corporate values, and accepted medical standards for consistent application across all business lines.
  • Oversee the Healthcare Policy Reference Manual (HPRM), including maintaining resource files and publications. Ensure the distribution of healthcare policies and operational procedures to internal and external stakeholders in accordance with organizational protocols and regulatory standards.

QUALIFICATIONS:

Education:

Bachelor’s Degree in Nursing, Public Health, English, or a related field pertinent to the role, OR, in lieu of a bachelor’s degree, an additional 4 years of relevant work experience is required in addition to the required work experience.


Licenses/Certifications:

  • RN - Registered Nurse - State Licensure And/or Compact State Licensure Registered Nurse (RN).
  • Certified Coder (CCS or CPC) - AHIMA or AAPC Certified Professional Coder (CPC) within 1 Year.

Experience:

  • Minimum of 3 years of clinical experience in Medical Surgical, Mental Health, Durable Medical Equipment, and/or Utilization Management, with some experience in research methodology and systematic evaluation of medical literature and the translation of evidence into policy within a healthcare environment.

PREFERRED QUALIFICATIONS:

  • Certified Professional Coder (CPC).
Knowledge, Skills, and Abilities (KSAs):

  • Strong analytical skills to assess critical information, make informed decisions, and resolve job-related challenges. A demonstrated commitment to knowledge sharing and teamwork.
  • Exceptional written and verbal communication abilities, with the capacity to present information to internal stakeholders at all levels.
  • Familiarity with medical insurance and managed care principles, as well as knowledge of CPT and ICD-10 coding systems. Understanding of various medical necessity determinations across different service locations and provider types.
  • Awareness of principles, practices, evidence-based guidelines, and standardized processes for evaluating medical support operations and business practices.
  • Ability to meet established deadlines and manage multiple customer service requests from both internal and external clients, maintaining high standards of service excellence. Proficient in providing effective communication and positive customer service to all stakeholders, including those who may present challenges.

SALARY RANGE:
$64,224 - $127,556

Salary Range Disclaimer:

The disclosed salary range has not been adjusted for geographic differentials associated with the work location. This compensation range considers factors such as the scope and responsibilities of the position, the candidate's experience, education/training, internal equity, and market considerations.

It is uncommon for an individual to be hired at the top of the range, as compensation decisions are based on the specific circumstances of each case, including experience, internal equity, and location.

In addition to your salary, the organization offers a comprehensive benefits package, various incentive programs, and 401k contribution plans (all benefits/incentives are subject to eligibility requirements).

Department:

Healthcare Policy

Equal Employment Opportunity:

The Blue Cross and Blue Shield Association is an Equal Opportunity (EEO) employer.

It is the policy of the organization to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

PHYSICAL DEMANDS:
The associate primarily works in a seated position while performing job duties. Occasional walking or standing may be required. Frequent use of hands for writing, typing, and handling small controls and objects is necessary. The associate must regularly communicate verbally and audibly. Lifting weights up to 25 pounds may occur occasionally.

Sponsorship in the U.S.:
Must be eligible to work in the U.S. without sponsorship.

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