Coverself Technologies - Research Policy Analyst

About CoverSelf :

CoverSelf empowers US healthcare payers with a truly next-generation, cloud-native, holistic, and customizable platform designed to prevent and adapt to the ever-evolving inaccuracies in healthcare claims and payments.

By reducing complexity and administrative costs, we offer a unified, healthcare-dedicated platform backed by top VCs like BeeNext, 3One4 Capital, and Saison Capital.

Key Responsibilities :

• Identify, interpret, develop, and implement concepts to detect incorrect healthcare payments through regulatory research, industry expertise, and data analysis.
• Analyst to support managing 1-2 medical reimbursement payment policies end-to-end.
• Manager and above to manage 2-3 medical reimbursement payment policies end-to-end.
• Develop and maintain coding guidelines, Medicare / Medicaid edits, and reimbursement frameworks.
• Analyze medical reimbursement methodologies, including policy rules and edits.
• Synthesize complex clinical and coding guidelines into actionable business logics
• Ensure compliance and update rules according to the latest industry standards.
• Leverage expertise in medical coding, healthcare claims processing, and industry standards to support the development of clinical coding policies and edits.
• Operate independently as an individual Strong domain expertise in denials logic across Payment Integrity, and Denials Management.
• Solid understanding of medical coding & billing methodologies and guidelines, including CPT, ICD, LCD / NCD, PTP, NCCI, edits, modifiers, Medicare Physician fee schedule, and coding conventions.
• Proficiency in data collection, analysis, and deriving actionable insights from CMS medical policies, Medicaid Provider Manuals and other Medical publications.
• Translate industry references into actionable business logic to support new rules and policy enhancements.
• Strong understanding of claim forms like UB-04 / CMS 1450 and CMS 1500
• Collaborate effectively across teams while managing multiple priorities
• Ability to thrive in a fast-paced, dynamic environment with minimal supervision.
• Demonstrated mindset for continuous learning and improvement and apply insights to policy development, refinement and maintenance.
• Strong stakeholder management, interpersonal, and leadership skills.
• Solution-focused, motivated, entrepreneurial spirit with a strong sense of ownership.
• Clear and effective communication.
• Strong attention to accuracy and detail in all Requirements :
• Must hold any of the following certifications : CPC, CPMA, COC, CIC, CPC-P, CCS or any specialty certifications from AHIMA or AAPC.
• Additional weightage will be given for AAPC specialty coding certifications.
• Lean Six Sigma certification and practical application experience are preferred

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