Healthcare Payment Policy Analyst

P32HS Point32Health Services Inc; Canton (MA); Hybrid; USD 64,000 - 96,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Retirement plans

Paid time off

Life and disability insurance with buy

Tuition program

Well-being benefits

Job summary

Point32Health is seeking a Policy Analyst to investigate, research, and resolve first- and second-level appeals and maintain payment policies. You’ll analyze financial impact of policy changes and collaborate with teams across Medical Policy and Utilization to support decision making and savings opportunities.

The role requires a bachelor's degree (master's preferred), 3–5 years in health care or related fields, and certification within one year.

Qualifications

• Bachelor’s degree or equivalent experience in health care or related field
• Certification within 1 year of hire
• 3-5 years of related work experience
• Experience in managed care or insurance compliance
• Strong written and verbal communication

Responsibilities

• Manage daily assigned appeal volume for first and second level appeals.
• Research proposed policies and policy changes by accurately defining financial impact.
• Development and ongoing maintenance of payment policies
• Utilize coding knowledge of CPT, HCPCS, ICD-10-CM and policy concepts to assist in edits and projects
• Meet deadlines and deliverables and mentor for team members as needed

Skills

Communication

Policy research

Attention to detail

Team collaboration

Education

Bachelor's degree

Master's degree

Tools

CPT coding

HCPCS coding

ICD-10-CM

Job description

Point32Health is seeking a Policy Analyst to investigate, research, and resolve first- and second-level appeals and maintain payment policies. You’ll analyze financial impact of policy changes and collaborate with teams across Medical Policy and Utilization to support decision making and savings opportunities.

The role requires a bachelor's degree (master's preferred), 3–5 years in health care or related fields, and certification within one year.