About SCAN

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 277,000 members in California, Arizona, Nevada, Texas and New Mexico. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 45 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.

The Job

The Medical Policy Clinical Analyst reviews and evaluating existing clinical policies, proposes suggested improvements to existing clinical policies, and research new policies. Responds to requests for information/clarification on Medicare/Medicaid regulation. Supports the business as a subject matter expert in interpretation of regulations.

You Will

Provides analytic and research support for Medical Policy regulation identification and interpretation activities.

Utilizes knowledge of compliance principles and practices combined with working knowledge of Medicare/Medicaid regulations to develop meaningful and compliant policies.

Researches and interprets complex statutes and regulations and dissects complex organizational and process issues.

Supports Medical Policy in following the Medical Policy Governance Process.

Supports the communication functions of the Center.

This position requires contributions to team effort by accomplishing and sharing related results with other staff.

Contributes to team effort by accomplishing related results as needed.

Your Qualifications

Bachelor's Degree or equivalent experience.

CA Registered Nurse (RN) current & active required.

May consider LVN with appropriate experience.

Certification from AAPC (CPC) and/or AHIMA (CCS or CCS-P) is a plus.

3+ years of experience in medical coding (CPT, ICD-9, ICD-10).

2+ years of analyst experience required.

Experience in the Medicare health plan environment, specifically involving coding and/or compliance work.

Expertise in CMS Medicare/Medicaid regulations required.

Experience coordinating and communicating between contacts in various departments as well as responding to delegated groups.

Technical expertise - Advanced analytical skills

Problem Solving - Basic problem-solving skills

Communication - Good communication and interpersonal skills

Proficiency in clinical policy through skills in literature searching and clinical research analysis based on the best available evidence or via direct work experience.

Working knowledge of clinical policies. Understanding of the managed care industry and market conditions.

High organizational and time-management skills; ability to work independently. Excellent and clear written and verbal communication skills.

Strong analytical and problem-solving skills. Ability to work in a cross-functional, professional environment.

Exceptional team player with a strong ability to contribute positively to a team environment with a desire to learn, grow, and empower.

Ability to perform independent research on complex medical topics.

Maintains professional and technical knowledge by conducting research and by attending educational and technological workshops.

Ability to adapt and demonstrate flexibility.

Demonstrated ability to prioritize multiple and competing tasks and work independently and in a team environment. Ability to work well in a fast-paced and dynamic environment.

Working knowledge of Tableau and/or Alteryx; Intermediate to advanced proficiency in Microsoft Office.

What's in it for you?

Base salary range: $80,300 to $128,500 per year
Remote Work Mode
An annual employee bonus program
Robust Wellness Program
Generous paid-time-off (PTO)
Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
Excellent 401(k) Retirement Saving Plan with employer match and contribution
Robust employee recognition program
Tuition reimbursement
An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)

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Medical Policy Clinical Analyst