Payment Policy Research Analyst

Sentara Health; United States; On-site; USD 106,000 - 163,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

401k/403B with Employer Match

Tuition Assistance

Student Debt Pay Down

Paid Time Off & Parental Leave

Job summary

Sentara Health is seeking a Payment Policy Research Analyst & Technical Writer in Virginia Beach, VA. The role focuses on identifying cost-saving opportunities in payment policies for Sentara Health Plan and presenting findings to leadership.

Responsibilities include researching policies, developing policy enhancements, and delivering savings through implementation. Requires CPC certification within six months and strong data and writing skills.

Qualifications

• Requires data-driven analysis of cost savings opportunities
• Experience presenting findings to diverse stakeholders
• Policy development or enhancement with reimbursement focus
• CPC certification or CPC within 6 months of hire preferred
• Strong writing and editing for technical policy documents

Responsibilities

• Research and assess internal payment policies for cost savings opportunities
• Identify strategies to achieve savings through policy changes or contract edits
• Support analytical investigations for opportunity development
• Build relationships with internal/external stakeholders to deliver payment initiatives
• Influence leadership to adopt new ideas and approaches

Skills

Policy analysis

Data insights

Presentation skills

Technical writing

Stakeholder collaboration

Education

High School Diploma or equivalent

Bachelor's degree preferred

Tools

Excel

PowerPoint

Outlook

Job description

Location and Work Shift

City/State: Virginia Beach, VA

Work Shift: First (Days)

Job Title

Payment Policy Research Analyst & Technical Writer

Job Description

Responsible for the identification, development, and presentation of new policy-related medical cost savings opportunities on behalf of Sentara Health Plan (SHP). Assess opportunities based on data insights leveraging tools, policies, industry trends, and by soliciting input from subject matter experts across SHP. Work with internal and external business constituents to determine opportunities for growth within our core payment/reimbursement policies and be responsible for savings delivery through deployment.

Primary Responsibilities

• 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

Preferred

• 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

Compensation

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.

Benefits

• 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
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down – $10,000
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

Equal Opportunity & Diversity

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce.

Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission “to improve health every day,” this is a tobacco-free environment.

Remote Work Eligibility States

For positions that are available as remote work, Sentara Health employs associates in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

About the Employer

Sentara Health is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years. Offering hundreds of sites of care including 12 hospitals, PACE, home health, hospice, medical groups, imaging services, therapy, outpatient surgery centres, and an 858,000 member health plan. The people of the communities that we serve have nominated Sentara “Employer of Choice” for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years. Sentara offers professional development and a continued employment philosophy!