Payment Policy Analyst

P32HS Point32Health Services Inc; Canton (MA); On-site; 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

Who We Are

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work. We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health.

Job Summary

The Policy Analyst will be responsible for investigating, researching, and resolving all first and second level appeals. Maintenance of payment policies; annually and ad-hoc. The payment policy analyst will have the ability to identify and research health care trends to support Payment Policy, Medical Policy and utilization for decision making recommendation and savings opportunities.

Key Responsibilities/Duties – what you will be doing (top five):

• 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 comprehensive coding knowledge of CPT, HCPCS, ICD-10-CM, benefit, provider reimbursement and medical policies to assist in implementation of edits, policies or projects as required.
• Meet deadlines and commitments by managing deliverables.
• Act as a resource and/or mentor for team members, Provider Relations, Member Services, or other internal departments.
• Perform other related duties as assigned by Manager of Payment Policy.
• Perform out-of-the-box thinking, collaborate with others, and make a difference every day.

Qualifications – what you need to perform the job

• Certification and Licensure Certified coder (CPC, COC, RHIT,CCS or CCS-P) is a plus, certification is required within 1 year of hire.
• Education Required (minimum): Bachelor’s degree or equivalent experience in health care or related field
• Preferred: Master’s degree
• Experience Required (minimum): 3-5 years of related work expeirance.
• Preferred: 3-5 years related healthcare experience in research analysis.
• 1 year experience in health care, managed care, or insurance compliance.

Skill Requirements

• Knowledge of state and federal mandates.
• Excellent verbal & written communication skills.
• Resilient, collaborative, flexible, innovative.

Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):

Must be able to work under normal office conditions and work from home as required. Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations. May be required to work additional hours beyond standard work schedule.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

Salary Range

$63,791.53 -$95,687.29

Compensation & Total Rewards Overview

The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company’s sole discretion and may be modified at the Company’s sole discretion, consistent with the law. Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

Benefits

• Medical, dental and vision coverage
• Retirement plans
• Paid time off
• Employer-paid life and disability insurance with additional buy-up coverage options
• Tuition program
• Well-being benefits
• Full suite of benefits to support career development, individual & family health, and financial health

For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/

We welcome all All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.