Payment Policy and Reimbursement Analyst
2 weeks ago
This position is responsible for maintaining and adhering to internal controls, ensuring compliance with applicable laws and regulations, and following Health New England’s entity level policies and procedures. The position is responsible for reporting unethical or fraudulent activity related to business operations and adhering to Health New England’s Code of Conduct.
Summary: Provide a brief summary of the purpose of this role. Include the role’s primary responsibility, its impact on end results, and the degree of freedom to act.
The Payment Policy and Reimbursement Analyst ensures claim payment integrity through the accurate application of industry pricing and coding by internal and external administration of claims editing and pricing of HNE claims as well as supporting the payment policy development and maintenance process. The Payment Policy and Reimbursement Analyst supports HNE cost savings efforts through payment policy and internal initiatives from conception, implementation and savings monitoring as well as issue identification, root cause analysis and resolution for payment integrity related issues.
Essential Functions: List in order of importance the essential duties and responsibilities of this role, and estimate the percentage of time spent on each. Include management and supervisory responsibilities, if any.
Payment Policy Support and Development 50%
- Lead payment policy development and review through the facilitation of workgroup and committee meetings ensuring all policies are up to date and structured process is followed.
- Leads cross-departmental introduction, adoption or modification of payment policies as necessary due to regulatory changes, contractual changes, as a result of claims data findings, or internal decision-making.
- Serve as company’s reimbursement expert regarding payment policies against all lines of business
- Collaborate with internal departments to define requirements and document those requirements sufficiently to ensure accurate implementation of payment rules within the adjudication system
- Coordinate other payment policies efforts with other internal initiatives including edit development to ensure payment policies align with current system configuration, medical policy or any member/provider documentation.
- The Payment Policy and Reimbursement Analyst serves as a resource to HNE providers and internal departments regarding billing issues and appeals specific to payment reimbursement policies and inquiries.
- Assist contracting and provider relations with communication to providers related to payment policies and methodologies
Cost Savings and Overpayment Recovery Efforts 30%
- Supports cost savings and overpayment/recovery efforts through data mining, pre-payment solutions, trend analysis, policy research and resolution.
- Review of reimbursement and overpayments related to payment policies and supporting edits. Supports efforts for new vendor edit or internal/external cost savings initiatives from concept development, research, vetting through data analysis, testing, post prod monitoring, internal communication, edit savings and performance.
- Supports the claims coding software through analysis of current CCI and CMS changes and appropriate application of rules based processing, and claims pricing through correct application of various industry standard fee schedules through 3rd party vendor pricing.
- Audits complex hospital and provider contracts compared to claim payment systems in order to confirm appropriate configuration designs and payment policy application
- Supports troubleshooting of vendor problems, provider appeals and inquiries to identify improvement areas internally through data analytics collaborating closely with all internal stakeholders to prepare solutions and resolve issues presenting to Management as required.
Special Projects 20%
- Supports management with special projects and any cost savings strategic team efforts to achieve payment integrity goals.
Bachelor’s degree with a minimum of 5 years of related experience and/or training; or an equivalent combination of education and experience.
- Prior payment policy development required
- Considerable knowledge of DRG, ICD-10, CPT-4 and HCPCS coding
- CPC certification preferred
- Prior health claims adjudication experience preferred
- Excellent communication skills (both verbal and written), with vendor, client, and internal stakeholders
- Strong technical writing, critical thinking, problem solving, and conflict management skills
- Able to handle multiple assignments/responsibilities simultaneously ensuring appropriate organization and prioritization of such responsibilities
- Math and decision-making skills are important for assisting in the selection of vendors that best fit the company's needs
-
Policy Analyst
3 days ago
Springfield, Virginia, United States Allen Integrated Solutions LLC Full timeJob SummaryWe are seeking a highly skilled Policy Analyst to join our team at Allen Integrated Solutions LLC. As a Policy Analyst, you will play a critical role in providing expertise and guidance to our clients and project teams.Key ResponsibilitiesExpertise and Guidance: Provide specialized in-depth expertise in fields such as engineering, technology,...
-
Policy Analyst
4 weeks ago
Springfield, United States TRINITY GLOBAL CONSULTING Full time $115,000 - $120,000Job DescriptionJob DescriptionOverall Assignment Description:Seeking a Program Analyst to support the National Geospatial-Intelligence Agency’s Cybersecurity Office as the lead project scheduler. Primary responsibility is to serve as the lead scheduler for the Cybersecurity Office’s Integrated Master Schedule. The individual will coordinate with multiple...
-
Policy Strategist
1 day ago
Springfield, Virginia, United States Booz Allen Hamilton Full timeJob Summary:As a Policy Analyst at Booz Allen Hamilton, you will provide expertise and guidance to clients on commercial GEOINT data and services. Your role will involve informing the integration of new data sets across multiple classified and unclassified domains, ensuring the quality and accuracy of policy, analyst, technology, experience, and commercial...
-
Policy Analyst
2 days ago
Springfield, Virginia, United States Masego Inc Full timeAbout the RoleMasego Inc. is seeking a highly skilled Policy Analyst to join our team. As a Policy Analyst, you will play a critical role in providing expertise, guidance, and consultation to our clients and project teams.Key ResponsibilitiesProvide specialized expertise and guidance to clients and project teams on geospatial intelligence, policy, and...
-
Senior Policy Analyst
6 days ago
Springfield, Virginia, United States Allen Integrated Solutions LLC Full timeJob DescriptionAllen Integrated Solutions LLC is seeking a highly skilled Policy Analyst - Senior Level to join our team. As a key member of our organization, you will be responsible for providing expertise, guidance, consultation, facilitation, and thought leadership to our clients and project teams based on your specialized in-depth knowledge in fields...
-
Senior Program Policy and Budget Analyst
1 week ago
Springfield, Virginia, United States WiSC Enteprises Full timeAbout the RoleWe are seeking a highly skilled Senior Program Policy and Budget Analyst to join our team at WiSC Enterprises. As a key member of our organization, you will play a critical role in providing strategic support to our clients and driving business growth.Key ResponsibilitiesCollect and analyze budget data to inform business decisions and drive...
-
Senior Program Policy and Budget Analyst
2 weeks ago
Springfield, Virginia, United States WiSC Enteprises Full timeAbout the RoleWe are seeking a highly skilled Senior Program Policy and Budget Analyst to join our team at WiSC Enterprises. As a key member of our organization, you will play a critical role in providing strategic support to our clients and driving business growth.Key ResponsibilitiesCollect and analyze budget data to inform business decisions and drive...
-
Policy Analyst
1 month ago
Springfield, United States Booz Allen Hamilton Full timePolicy AnalystKey Role:Provide expertise, guidance, consultation, facilitation, and thought leadership to the client around commercial GEOINT data and services. Inform the integration of new data sets across multiple classified and unclassified domains and ensure that quality is an integral part of the development. Design and deliver commercial GEOINT...
-
Planning, Policy, Business Analyst
4 weeks ago
Springfield, United States Viperion Tech Llc Full timeJob DescriptionJob Description The Expeditionary Operations Office is seeking contractors to support the Global Expeditionary & Operational Support Team (XO-GEOS). Requirements include, but are not limited to: • Lead the coordination of the quarterly Global Expeditionary & Operational Support Team (XO-GEOS) and update presentations for the Director...
-
Planning, Policy, Business Analyst
3 weeks ago
Springfield, United States Viperion Tech Llc Full timeJob DescriptionJob DescriptionThe Expeditionary Operations Office is seeking contractors to support the Global Expeditionary & Operational Support Team (XO-GEOS). Requirements include, but are notlimited to: Lead the coordination of the quarterly Global Expeditionary & Operational Support Team (XO-GEOS) and update presentations for the Director and KC...
-
GEOINT Policy Analyst
2 months ago
Springfield, United States The ACI Group, Inc. Full timeGEOINT Policy Analyst (TS/SCI Cleared), Springfield, VAFull-timeOn-Site: Springfield, VA CLEARANCE: Requires an active TS/SCI clearance to start. May be processes for a Poly at some point.DescriptionSeeking a GEOINT Policy Analyst with a TS/SCI clearance to support work with NSG.ResponsibilitiesProviding expertise, guidance, consultation, facilitation, and...
-
GEOINT Policy Analyst
2 months ago
Springfield, United States The ACI Group, Inc. Full timeGEOINT Policy Analyst (TS/SCI Cleared), Springfield, VAFull-timeOn-Site: Springfield, VA CLEARANCE: Requires an active TS/SCI clearance to start. May be processes for a Poly at some point.DescriptionSeeking a GEOINT Policy Analyst with a TS/SCI clearance to support work with NSG.ResponsibilitiesProviding expertise, guidance, consultation, facilitation, and...
-
Payment Integrity Specialist I
3 months ago
Springfield, United States Health New England Full timeJob DescriptionJob DescriptionThis position is responsible for maintaining and adhering to internal controls, ensuring compliance with applicable laws and regulations, and following Health New England’s entity level policies and procedures. The position is responsible for reporting unethical or fraudulent activity related to business operations and...
-
Policy Analyst
2 days ago
Springfield, United States Booz Allen Hamilton Full timePolicy AnalystKey Role:Provide expertise, guidance, consultation, facilitation, and thought leadership to the client around commercial GEOINT data and services. Inform the integration of new data sets across multiple classified and unclassified domains and ensure that quality is an integral part of the development. Design and deliver commercial GEOINT...
-
Claims Integrity Analyst I
2 weeks ago
Springfield, Massachusetts, United States Health New England Full timePosition OverviewThe Claims Integrity Analyst I plays a crucial role in ensuring adherence to internal controls and compliance with relevant laws and regulations. This position is integral to upholding the ethical standards of Health New England and involves reporting any unethical or fraudulent activities related to business operations.Role Summary: This...
-
Policy Analyst
2 months ago
Springfield, United States Integrated Intel Solutions Full timeJob DescriptionJob DescriptionSCD Position 9: Policy Analyst Skill Level 4 (NGA-W)Duties include:Providing expertise, guidance, consultation, facilitation, and thought leadership to the client and/or project team based on specialized in-depth expertise in such fields as: engineering and technology; policy and administration; planning; analysis;...
-
Policy Analyst
2 months ago
Springfield, United States Integrated Intel Solutions Full timeJob DescriptionJob DescriptionSCD Position 9: Policy Analyst Skill Level 4 (NGA-W)Duties include:Providing expertise, guidance, consultation, facilitation, and thought leadership to the client and/or project team based on specialized in-depth expertise in such fields as: engineering and technology; policy and administration; planning; analysis;...
-
GEOINT Policy Specialist
1 week ago
Springfield, Illinois, United States Booz Allen Hamilton Full timePosition Overview:The Policy Analyst will serve as a pivotal resource, offering specialized knowledge, strategic guidance, and collaborative support to clients regarding commercial GEOINT data and services. This role involves facilitating the integration of new data sets across both classified and unclassified environments, ensuring that quality assurance is...
-
Strategic Policy Consultant
1 week ago
Springfield, Illinois, United States Booz Allen Hamilton Full timePosition Overview:The Policy Analyst will serve as a pivotal resource, offering specialized knowledge, strategic advice, and leadership to clients regarding commercial GEOINT data and services. This role involves guiding the integration of diverse data sets across both classified and unclassified environments, ensuring that quality assurance is a fundamental...
-
Government Policy Specialist
2 weeks ago
Springfield, Illinois, United States The Maven Group, LLC Full timePosition OverviewThe Maven Group, LLC is seeking a qualified individual for the role of Policy Analyst. This position is pivotal in ensuring the effective management and oversight of data accessibility and discoverability.Key Responsibilities:Evaluate and enhance the discoverability and accessibility of essential data.Monitor the lifecycle of products and...