Payment Policy Research Analyst
About The Position
The Payment Policy Research Analyst & Technical Writer identifies, develops, and presents policy-related medical cost-saving opportunities for Sentara Health Plan (SHP). The role assesses opportunities using data insights, tools, policies, industry trends, and input from subject matter experts across SHP. The analyst works with internal and external business constituents to identify growth opportunities in core payment and reimbursement policies and delivers savings through deployment. This position offers a remote work schedule opportunity. Candidates should be able to present, collaborate, and consult with stakeholders across functional areas; manage concurrent projects against tight timelines; and work innovatively in an ambiguous, growth-oriented environment. The role requires intermediate Excel, PowerPoint, and Outlook skills. The posted annual base pay range for full-time employment is $105,560.00–$162,552.00. Compensation may vary based on qualifications, experience, location, market conditions, and business needs. Additional compensation may be available, and eligible colleagues may earn an annual discretionary bonus. Sentara offers medical, dental, vision, life, and disability coverage; retirement plans with employer match; paid time off and leave; educational assistance; and other benefits.
Requirements
- High school diploma or equivalent required.
- Certificate of Professional Coder (CPC) 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 varied stakeholders or clients across multiple functional areas.
- Experience managing multiple concurrent projects and meeting tight delivery timelines.
- Ability to work innovatively in an ambiguous, growth-oriented environment.
- Intermediate Excel skills, including creating spreadsheets, manipulating data, and creating pivot tables or reports.
- Intermediate PowerPoint skills, including creating professional presentations.
- Intermediate Outlook skills, including scheduling meetings, coordinating, and tracking tasks.
Nice To Haves
- Bachelor-level degree preferred.
- At least 3 years of health plan claim auditing or appeals experience preferred.
- BS, BA, or advanced degree in a healthcare or medical field 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 against competitors and industry standards to identify cost-saving opportunities.
- Determine strategies or solutions to achieve identified savings, such as policy development or enhancement, authorization criteria and processes, contract strategies, and claims editing.
- Conduct analytical, investigative, and other fact-finding work to support opportunity development.
- Build relationships with internal and external stakeholders to define, align, and deliver payment initiatives and new or enhanced policies in support of health plan goals.
- Influence leadership to adopt new ideas, approaches, or products.
- Develop and present policy-related medical cost-saving opportunities.
Benefits
- Medical, dental, and vision plans.
- Adoption, fertility, and surrogacy reimbursement up to $10,000.
- Paid time off and sick leave.
- Paid parental and family caregiver leave.
- Emergency backup care.
- Long-term and short-term disability and critical illness plans.
- Life insurance.
- 401(k)/403(b) with employer match.
- Tuition assistance up to $5,250 per year and discounted educational opportunities through Guild Education.
- Student debt paydown up to $10,000.
- Pet insurance.
- Legal resources plan.
- Opportunity to earn an annual discretionary bonus subject to established system and employee eligibility criteria.
- Paid holidays.
- Educational assistance or student loan repayment.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
