IBR Policy and Content Development Analyst

About the role

Develop, enhance, and maintain clinical and coding solutions as the primary expert on payment integrity policies. Ensure audit concepts are built, validated, and kept in line with coding standards, medical necessity criteria, and payer policies.

What you will do

• Review and update audit concepts on regular cycles or after client or regulatory changes, including research, claim analysis, and rule docum
• Research regulatory, coding, and payer policy changes and document how they affect existing concepts
• Embed state Medicare and Medicaid provider manuals and regional mandates into audit concept configurations
• Evaluate payer policies to find gaps and propose new audit concepts to clients
• Align concepts with CMS, MUEs, and CPT/HCPCS guidelines and build those targeting coding unbundling under NCCI edits
• Test new concepts to confirm automated logic performs correctly before implementation

What they look for

• Extensive knowledge of medical coding systems and payment methodologies
• Strong analytical and communication skills