Payment Policy Research Analyst
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City/State Virginia Beach, VA
Work Shift
First (Days)Overview:
Payment Policy Research Analyst
Payment Policy Research Analyst & Technical Writer is responsible for the identification, development & presentation of new policy-related medical cost savings opportunities on behalf of Sentara Health Plan (SHP). You will assess new opportunities based on data insights leveraging tools, policies, industry trends & by soliciting input from subject matter experts across SHP. You will work with internal & external business constituents to determine opportunities for growth w/in our core payment/reimbursement policies & be responsible for savings delivery through deployment.
Research & assessment of internal payment policies & payment solutions in relation to competitors & industry standards to identify new cost savings opportunities
Determine potential strategies &/or solutions to achieve identified cost savings such as policy development or enhancement, authorization criteria & process, contract strategy, claims editing & more
Participate in analytical, investigative & other fact-finding work in support of opportunity development
Establish strong relationships with internal & external stakeholders to define, align & deliver payment initiatives & new/enhanced policy development in support of health plan goals
Influence leadership to adopt new ideas, approaches &/or products
Education
- High School Diploma or equivalent (Required)
- Bachelor Level Degree (Preferred)
Certification/Licensure
- Certificate of Professional Coder- CPC Certification (Required)
Experience
- 3 years Health plan experience or 3 years Medical coding, required
- 3 years Health plan claim auditing or appeals, preferred
- BS/BA/Advanced degree in health care or medical field preferred
- CPC required within first 6 months of hire
- Remote Work Schedule Opportunity
Qualified Candidates will possess:
Experience presenting, collaborating & consulting with a variety of stakeholders or clients across multiple functional areas
Experience managing multiple concurrent projects & meet tight delivery timelines
Innovative thinker that works well in an ambiguous, growth environment
Intermediate computer skills with Excel, PowerPoint & Outlook with minimal supervision:
Excel - Create spreadsheets, manipulate data & create pivot tables/reporting
PowerPoint - Create professional looking presentations
Outlook - Schedule meetings, coordination, task tracking
Knowledge of statistical methods used in the evaluation of healthcare claims data
Professional & Institutional reimbursement experience includes coding certifications
Reimbursement policy &/or technical writing experience for development & publication We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay range for full-time employment is $105,560.00 - $162,552.00 annually. Additional compensation may be available for this role, such as shift differentials, on-call pay, shift premiums, extra-shift incentives, or bonus opportunities. Compensation within the range may vary based on qualifications, experience, location, market conditions, and business needs. Note: If an annual salary is posted, it is based on a full-time colleague working 2,080 hours annually. Sentara offers a comprehensive benefits package, including medical, dental, vision, life and disability insurance; 401(k)/403(b) with employer match; paid time off (vacation, sick time, and holidays); paid parental and military leave; educational assistance or student loan repayment; and voluntary benefits.
Benefits: Caring For Your Family and Your Career
• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
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