Experian is a global data and technology company, powering opportunities for people and businesses around the world. We help to redefine lending practices, uncover and prevent fraud, simplify healthcare, create digital marketing solutions, and gain deeper insights into the automotive market, all using our unique combination of data, analytics and software. We also assist millions of people to accomplish their financial goals and help them to save time and money.

We operate across a range of markets, from financial services to healthcare, automotive, agrifinance, insurance, and many more industry segments.

We invest in people and new advanced technologies to unlock the power of data and to innovate. A FTSE 100 Index company listed on the London Stock Exchange (EXPN), we have a team of 23,300 people across 32 countries. Our corporate headquarters are in Dublin, Ireland. Learn more at experianplc.com.

As Senior Managed Care Policy Analyst, you will manage the accurate representation of medical rules/edits from any source. You'll build and use all tables and work with clients regarding Technical Support Issues identified. You may review and make recommendations regarding Level I and Senior coding, placement, and logic. You'll be responsible not only for assisting with building tables associated with new products or technology but also the release and review of content into production for client use. You'll make recommendations and assist with data/tables for new products. You will report to the Senior Director, Compliance Data.

You will:

• Identify necessary and potential changes to existing medical rules through review of current and historically available hardcopy medical policies, transmittals and bulletins. This includes revision and retirement of existing policies and the addition of new policies.
• Extract information from resources and translate information needed to form appropriate logic for rules, documentation and quality assurance review. Complete Clinical Transaction Engine table builds (used by eCN Medical Necessity and ClaimSource) with completion of integrity checks Review of edit modification for medical procedures for clear representation varying levels of ICD-10-CM diagnoses.
• Assign CPT/HCPS codes for PreCertification product table(s) where contractor supplies narrative condition only. Also participate in review of National NCD's for National policies, assigning appropriate diagnosis and procedural codes to be reviewed by Director and for strategic inclusion into Medicare medical edits.
• Independently prepare and make appropriate adjustments to any data editorial for release to production
• Prepare reports and documents for Director review including coding trends, documentation requirements, related payer changes and concerns.
• Complete reviews of medical policies and publications and its integration into the required database. Identify patterns of improper coding or errors in policies and publications and can resolve and recommend alternate codes, or code representation is appropriate table(s) (Diagnosis, CPT/HCPCS, CCI_Edits)
• Complete in-depth, independent reviews of issues forwarded byCompliance Support. Compose responses and discuss with clients.
• Maintain all medical rules editorials in the appropriate database using programmatic tools.
• Analyze data and draw conclusions.
• Be responsible for accurate research of resources that update critical information on a scheduled basis. Stay up to date with current coding issues.

• Associate's or Bachelor's degree in the Life Sciences or Accredited Record Technician's certification (ART) or Certified Procedural Coder certificate (CPC) or outpatient Medical Coder experience or an equivalent combination of training, education and experience
• 4+ years experience with and knowledge of Current Procedural Terminology (CPT) Coding, and International Classification of Disease (ICD-10) Codes required. Must understand and retain coding information and transfer that information into completed product data.
• Experience researching and drawing conclusions regarding medical edits
• Knowledge of Medicare reimbursement guidelines
• Knowledge of Medical Terminology
• Knowledge of anatomy and physiology
• Standard English grammar/usage and proper telephone communication
• Write in a clear and understandable manner
• Previous Healthcare experience

Benefits/Perks:

• Great compensation package and bonus plan
• Core benefits including medical, dental, vision, and matching 401K
• Flexible work environment, ability to work remote, hybrid or in-office
• Flexible time off including volunteer time off, vacation, sick and 12 paid holidays
• Explore all our exciting benefits here: https://yourexperianbenefits.com/cand-index.html

At Experian, our people and culture set us apart. We're committed to creating an environment where everyone feels they belong and can excel. From inclusion and authenticity to work/life balance, development, wellness, collaboration, and recognition, we focus on what matters. Our people-first approach has earned us global recognition: World's Best Workplaces™ 2024 (Fortune Top 25), Great Place To Work™ 2025 in 26 countries, and Glassdoor Best Places to Work 2024, among others.

Want to see what life at Experian is really like? Explore Experian Life on social or visit our careers site.

Our compensation reflects the cost of labor across several U.S. geographic markets. The base pay range for this position is listed above. Within this range, individual pay is determined by work location and additional factors such as job-related skills, experience, and education. You will be also eligible for a variable pay opportunity.

Experian is proud to be an Equal Opportunity Employer for all groups protected under applicable federal, state and local law, including protected veterans and individuals with disabilities. If you have a disability or special need that requires accommodation, please let us know at the earliest opportunity.

#LI-Remote This is a remote position.