Job Description

Job Title: Policy and Documentation Analyst Medicare/Medicaid (DSNP)
Remote USA
6+ months

Job Summary:

We are seeking a detail-oriented and knowledgeable Policy and Documentation Analyst with strong experience in Medicare/Medicaid programs , specifically Dual Eligible Special Needs Plans (DSNP) . The ideal candidate will be responsible for drafting, formatting, and maintaining benefit and claims policies in alignment with federal and state regulations using the HealthRules Payor platform. This role involves translating complex regulatory and business requirements into clear, structured documentation for healthcare applications.

Key Responsibilities:

• Develop, write, and maintain comprehensive policy documents related to benefits and claims processing for DSNP plans.
• Ensure all policies align with Medicare and Medicaid regulations, CMS guidelines, and internal standards.
• Collaborate with product, compliance, business analysts, and configuration teams to gather requirements and clarify rules.
• Translate business and regulatory requirements into detailed, Word-based policy documentation that supports system configuration in HealthRules Payor .
• Maintain version control and a clear audit trail of all changes to documentation.
• Participate in reviews and audits to ensure documentation accuracy, completeness, and compliance.
• Provide subject matter expertise in healthcare payer operations, particularly DSNP eligibility, benefits, and claims processes .
• Work with technical and business teams to ensure policies are implementable and traceable.

Required Skills & Qualifications:

• Bachelor's degree in Healthcare Administration, Public Policy, Information Systems, or a related field.
• 3+ years of experience in documenting policies for Medicare/Medicaid or other government-sponsored health programs.
• Hands-on experience with DSNP policy development or benefit configuration.
• Familiarity with HealthRules Payor or similar healthcare payer systems.
• Strong writing, editing, and formatting skills in Microsoft Word .
• Solid understanding of CMS requirements, claims processing workflows, and benefit structures.
• Attention to detail with excellent organizational and analytical skills.

Preferred Qualifications:

• Experience with state-specific Medicaid policies or managed care organizations.
• Knowledge of healthcare data standards (e.g., HIPAA, ICD-10, CPT).
• Exposure to Agile or cross-functional project teams.

Job Tags

Similar Jobs