Payment Policy Research Analyst

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

Benefits offered by this job

Medical, Dental, Vision plans

401k/403B with employer match

Paid Time Off

Job summary

Sentara Health is seeking a Payment Policy Research Analyst to identify cost-saving opportunities within payment and reimbursement policies for the Sentara Health Plan. You will evaluate opportunities using data insights, industry trends, and SME input across SHP to deliver measurable savings through policy deployment.

You will build relationships with internal and external stakeholders to align on payment initiatives, influence leadership, and support policy development for health plan goals.

Qualifications

• Identify and develop policy-related medical cost savings opportunities.
• Assess opportunities using data insights, policies, and industry trends.
• Collaborate with stakeholders to deliver savings through policy development.

Responsibilities

• Research and assess internal payment policies to identify cost savings.
• Determine strategies to achieve savings, including policy changes or contract terms.
• Participate in analytical work to support opportunity development.

Skills

Policy research

Data analysis

Stakeholder management

Advanced Excel

PowerPoint

Outlook

Education

High School Diploma or equivalent

Bachelor's degree (Preferred)

Tools

Excel

PowerPoint

Outlook

Job description

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.

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

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
• 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.

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.

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.