Payment Policy Research Analyst

Sentara Health Plans; Virginia Beach (VA); À distance; USD 106 000 - 163 000; Plein temps

Avantages offerts par ce poste

Medical, Dental, Vision plans

401(k) with employer match

Paid Time Off

Résumé du poste

Sentara Health Plans is seeking a Payment Policy Research Analyst to identify cost-saving opportunities in payment policies. The role involves research, data-driven analysis, and collaboration with internal and external stakeholders to shape reimbursement strategies.

The position emphasizes policy development, publication, and presentation of findings with CPC certification required and 3 years of relevant experience.

Qualifications

• 3 years health plan experience or 3 years medical coding required.
• CPC certification required within first 6 months of hire.
• BS/BA/Advanced degree in health care or medical field preferred.
• Experience presenting, collaborating & consulting with stakeholders across functional areas.
• Intermediate Excel, PowerPoint & Outlook skills.

Responsabilités

• Research and assess internal payment policies and payment solutions to identify cost savings.
• Determine strategies or solutions to achieve identified cost savings.
• Participate in analytical and fact-finding work supporting opportunity development.
• Establish relationships with stakeholders to deliver payment initiatives and policy development.
• Influence leadership to adopt new ideas, approaches and/or products.

Connaissances

Excel

PowerPoint

Outlook

Stakeholder collaboration

Formation

High School Diploma or equivalent

Bachelor degree preferred

Outils

Excel

PowerPoint

Outlook

Description du poste

## Payment Policy Research AnalystApply: Remote: Virginia Beach, VA: Full time: Posted Today: JR-107843**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 & publicationWe 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.