Payor Policy Analyst - FT - Day - Managed Care Pennington NJ

Capital Health (US)•Hopewell, NJ

2d•Onsite

About The Position

The Payor Policy Analyst assists contract management with payor policy review, including assistance with development and implementation of strategies to support reimbursement at the state and federal levels. The Analyst is responsible for gathering and sharing information as it relates to policy, authorization, billing and reimbursement issues. Assessing payor policies to determine how they impact Capital Health revenue cycle, quality, patient satisfaction, patient access and other operational areas.

Requirements

Five years of experience in healthcare revenue cycle required.
Proficient in Microsoft Office.

Nice To Haves

Bachelor’s degree preferred.
Professional and hospital revenue cycle experience and exposure to policy interpretation and/or contracting preferred.

Responsibilities

Reviews and assesses new and existing payor policies for contracted Governmental, Commercial, and other third-party insurance carriers to assess impact on hospital and professional reimbursement, operations, revenue cycle service, quality, and patient satisfaction.
Maintains a proactive schedule for data gathering and review for upcoming changes and/or potential changes to payor policies and proposes strategic solutions to Capital Health leadership.
Assesses whether policies are following all state and federal regulations, especially Medicare and Medicaid requirements, finds variances with documented evidence, and escalates to Capital Health leadership for next steps (including but not limited to Revenue Cycle, Compliance, Operations, and Finance).
Supports efforts at the state and federal levels as appropriate by developing responses, talking points, and strategy on key issues while helping to ensure policy consistency across the organization.
Stays up to date with OIG, OAG, CMS, DHHS, and other state regulatory bodies for potential Federal and State changes in policies that will affect Capital Health.
Examines health care trends, monitors implementation of Government Health Care Acts to identify implications and potential opportunities and/or risk for Medicare, Medicaid and Commercial payors.
Interacts with industry groups to assess hospital market response, best practices, and reaction to policies.
Evaluates impact of policy changes and crafts compelling rebuttals to respond to health plans.
Creates analysis, assesses financial and operational impact of new policies, and provides a summary to the leadership team.
Creates draft objection letters for all payor policy changes that result in a significant financial impact.
Tracks, monitors, and assures Capital Health responds to payors based on policy matters.
Compares contract changes with health plan medical policies to identify if they are consistent.
Interacts and fosters relationships with DOH and other industry agencies to address concerns regarding payor policies.
Provides support to include attending Payor Relation meetings with Executive leadership to communicate specific policy concerns and denials trends.
Helps create, organize, and document communication surrounding policy updates, revisions, prior and post change to education and satisfy the needs of various departments and staff levels.
Performs additional duties to support team goals and company initiatives as needed.