Payment Policy Research Analyst

Sentara Hospitals • Virginia Beach, VA

8d • Remote

About The Position

The Payment Policy Research Analyst & Technical Writer identifies, develops, and presents policy-related medical cost savings opportunities for Sentara Health Plan (SHP). The analyst assesses opportunities using data insights, tools, policies, industry trends, and input from SHP subject matter experts. The role works with internal and external business constituents to identify growth opportunities in core payment and reimbursement policies and supports savings delivery through deployment.

The position researches internal payment policies and solutions in relation to competitors and industry standards, evaluates approaches to achieve savings, and contributes analytical and fact-finding work. It also builds stakeholder relationships to align and deliver payment initiatives and new or enhanced policies, and influences leadership to adopt new ideas, approaches, and products.

This role is described as a remote work schedule opportunity. The posted full-time annual base pay range is $105,560.00–$162,552.00. Compensation may vary according to qualifications, experience, location, market conditions, and business needs; additional compensation may also be available. An annual discretionary bonus may be available subject to system and employee eligibility criteria.

Requirements

• High school diploma or equivalent required.
• Certificate of Professional Coder (CPC) certification required; CPC must be obtained within the first six months of hire.
• At least 3 years of health plan experience or 3 years of medical coding experience required.
• Experience presenting, collaborating, and consulting with stakeholders or clients across multiple functional areas.
• Experience managing multiple concurrent projects and meeting tight delivery timelines.
• Innovative thinker able to work in an ambiguous, growth-oriented environment.
• Intermediate computer skills with Excel, PowerPoint, and Outlook, with minimal supervision. Excel skills include creating spreadsheets, manipulating data, and creating pivot tables or reports; PowerPoint skills include creating professional presentations; Outlook skills include scheduling meetings, coordination, and task tracking.

Nice To Haves

• Bachelor-level degree preferred; a BS, BA, or advanced degree in a health care or medical field is preferred.
• Three years of health plan claim auditing or appeals experience preferred.
• Knowledge of statistical methods used to evaluate healthcare claims data.
• Professional and institutional reimbursement experience, including coding certifications.
• Reimbursement policy or technical writing experience for development and publication.

Responsibilities

• Research and assess internal payment policies and payment solutions in relation to competitors and industry standards to identify new cost savings opportunities.
• Determine potential strategies or solutions for identified savings opportunities, including policy development or enhancement, authorization criteria and processes, contract strategy, and claims editing.
• Participate in analytical, investigative, and other fact-finding work to support opportunity development.
• Establish relationships with internal and external stakeholders to define, align, and deliver payment initiatives and new or enhanced policy development in support of health plan goals.
• Influence leadership to adopt new ideas, approaches, or products.
• Present, collaborate, and consult with stakeholders or clients across multiple functional areas.
• Manage concurrent projects and meet delivery timelines.

Benefits

• Medical, dental, and vision plans.
• Adoption, fertility, and surrogacy reimbursement up to $10,000.
• Paid time off, sick leave, and holidays.
• Paid parental and family caregiver leave; paid military leave is also listed in the comprehensive benefits package.
• Emergency backup care.
• Long-term and short-term disability and critical illness plans.
• Life insurance.
• 401(k)/403(b) with employer match.
• Tuition assistance of up to $5,250 per year and discounted educational opportunities through Guild Education.
• Student debt pay down up to $10,000; student loan repayment or educational assistance is also listed in the comprehensive benefits package.
• Pet insurance.
• Legal resources plan.
• Opportunity to earn an annual discretionary bonus, subject to system and employee eligibility criteria.
• Voluntary benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED