Payment Policy Analyst

Point32Health • Canton, MA

2d • Hybrid

About The Position

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.

Requirements

• Certified coder (CPC, COC, RHIT,CCS or CCS-P) is a plus, certification is required within 1 year of hire.
• Bachelor’s degree or equivalent experience in health care or related field
• 3-5 years of related work expeirance.
• Knowledge of state and federal mandates.
• Excellent verbal & written communication skills.
• Resilient, collaborative, flexible, innovative

Nice To Haves

• Master’s degree
• 3-5 years related healthcare experience in research analysis.
• 1 year experience in health care, managed care, or insurance compliance.

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 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.

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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree