Medical Policy Analyst – Part-Time, 32 hrs weekly

This is a fully remote position, open to applicants in Connecticut, +3 more states.

📋 Description

• Conduct evaluations of post-service medical necessity and appealed claims to ensure compliance with medical policies, plan benefits, and provider coding.

• Prepare cases for review by the Medical Director and/or external consultants when necessary.

• Provide prompt and precise responses to inquiries and collaborate with claims policy teams regarding claims awaiting medical review and appeal inquiries.

• Identify opportunities for the development or revision of Horizon Medical Policies based on the outcomes of case reviews.

• Manage assigned inventory, oversee document production, and ensure tasks are completed as assigned.

• Keep informed about mandates, policies, and workflow changes that affect the review process and its outcomes.

• Utilize knowledge of laws, regulations, and organizational policies in fulfilling job responsibilities.

⛳️ Requirements

• High School Diploma or GED is mandatory.

• A minimum of 3 years of clinical nursing experience is required.

• Proficient verbal and written communication skills are essential.

• Ability to collaborate effectively within a team setting.

• Adherence to professional and ethical business practices.

• Commitment to upholding company standards.

• Dedication to personal and professional growth.

• Demonstrated time management abilities.

• Capability to manage multiple priorities or tasks simultaneously.

• Ability to produce timely and accurate work products with a focus on customer service.

• Capacity to respond with urgency when necessary.

• Experience working in a production-oriented environment.

• Strong judgment and problem-solving skills.

• Ability to ask insightful questions and gather comprehensive, relevant information.

• Candidates must reside in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.

🏝️ Benefits

• Comprehensive health benefits including Medical, Dental, and Vision.

• Retirement Plans available.

• Generous Paid Time Off (PTO).

• Incentive Plans to reward performance.

• Wellness Programs to support employee health.

• Paid Volunteer Time Off for community involvement.

• Tuition Reimbursement for educational advancement.

• A mission-driven organization that values expertise, collaboration, and growth.

• Reasonable accommodation requests are supported during the recruitment and hiring process.