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cms data analysis medicaid ccs cpc📋 Description
- Source and scope new payment integrity policies for content library
- Prioritize updates by savings, impact, and alignment with goals
- Leverage CMS, Medicaid, and guidelines for new content opportunities
- Quantify policy value with data-driven ROI analyses
- Collaborate with product/engineering to align needs with development
- Serve as the payment integrity expert across enterprise initiatives
🎯 Requirements
- 5-7 years in payment integrity at a health plan or similar
- Active CPC or CCS certification (required)
- Interpreting medical and payment policies
- Applying CMS and Medicaid reimbursement guidelines
- Professional and outpatient coding standards
- Data-driven analysis of policy impact and ROI
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