Policy and Implementation Analyst in Remote, Utah - #72376 | VanderHouwen

Description

Job Id: 72376

Policy & Implementation Analyst
Our client is seeking a Policy and Implementation Analyst to support the development, implementation, and maintenance of healthcare reimbursement and clinical editing policies. This role will partner across operational, technical, and clinical teams to ensure accurate policy interpretation, system configuration, and claims adjudication outcomes. The ideal candidate brings strong analytical capabilities, healthcare policy knowledge, and experience working with coding, reimbursement, or claims-related systems in a regulated healthcare environment.

This role is fully remote. Applicants must be located in Oregon, Washington, Utah, or Idaho.

Policy & Implementation Analyst Responsibilities

• Analyze, develop, and implement reimbursement and clinical editing policies to support operational and financial objectives.
• Facilitate the gathering, documentation, and interpretation of business requirements related to policy implementation and claims editing processes.
• Create and manage implementation plans for policy updates, system configuration changes, and business process improvements.
• Develop and maintain reimbursement policy documentation, online reference materials, and technical implementation guides.
• Configure and support clinical edits, coding updates, and preauthorization rules within claims editing systems.
• Collaborate with clinical, operational, and technical teams to ensure policies and edits are implemented accurately and effectively.
• Research coding, reimbursement, and claims adjudication issues and provide recommendations for resolution.
• Analyze data and reporting to identify trends, cost management opportunities, process improvements, and operational risks.
• Design and execute testing plans to validate successful implementation of policy and system updates.
• Respond to internal and external inquiries related to reimbursement policy, coding guidance, and system functionality.
• Partner with medical directors and subject matter experts to ensure policies align with clinical best practices and regulatory requirements.
• Develop reports, queries, and analyses to support business decision-making and project initiatives.
• Coordinate communication efforts related to policy updates and implementation activities across stakeholders.

Policy & Implementation Analyst Qualifications

• Bachelor’s degree in Business Administration, Healthcare Administration, or a related field preferred, or equivalent professional experience.
• Minimum of 3 years of experience in a healthcare, reimbursement, claims, or policy-related analytical role.
• Working knowledge of reporting and analytical tools such as SQL, Oracle, SQL Server, SSRS, SAS, Crystal Reports, or similar business intelligence platforms preferred.
• Strong understanding of healthcare reimbursement methodologies, medical policies, and claims adjudication processes.
• Knowledge of CMS reimbursement policies, Medicare products, CPT/HCPCS procedure coding, and ICD-9/ICD-10 diagnosis coding required.
• Experience supporting or configuring clinical editing systems, reimbursement policies, or coding-related workflows preferred.
• Strong analytical and problem-solving skills with the ability to identify issues and implement effective solutions independently.
• Excellent written and verbal communication skills with the ability to present technical information clearly to diverse audiences.
• Experience creating technical documentation, implementation plans, testing strategies, and operational communications.
• Familiarity with healthcare documentation systems and claims processing environments.
• Proficiency with Microsoft Office applications including Excel, Word, and Outlook.
• Experience leveraging AI tools or emerging technologies to improve operational efficiency or analytical workflows is highly desired.
• Ability to collaborate effectively across clinical, operational, and technical teams in a fast-paced environment.
• RN licensure, coding certification, or other relevant healthcare certifications are preferred but not required.

Compensation: (DOE)

VanderHouwen Contractors Enjoy Exceptional Benefit Perks!
As an eligible contract employee with VanderHouwen, you’ll have access to a full suite of benefits designed with your well-being in mind. Our comprehensive package includes medical, dental, vision, life insurance, short- and long-term disability, and a matching 401(k) to help secure your future.

Meet VanderHouwen
What kind of recruiter do you see yourself working with? One who prioritizes your best interest, no matter what? VanderHouwen does, and we’re in it for the long game! Our recruiters focus on YOU, building meaningful, long-term relationships while developing a deep understanding of companies’ staffing needs and workplace cultures. This approach helps us find an ideal job match that aligns with your unique career aspirations and goals.

VanderHouwen is an award-winning, Women & Diversity-Owned, WBENC certified professional staffing firm. Founded in 1987, VanderHouwen places experienced professionals across the nation! Our recruitment teams specialize in either Technology and IT, Engineering, Human Resources, or Accounting and Finance career markets. Partner with us to land your next exciting career!

VanderHouwen is an Equal Opportunity Employer and participates in E-Verify. VanderHouwen does not discriminate based on race, color, religion, sex, national origin, age, disability, or any other characteristic protected by applicable local, state, or federal civil rights laws.

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