Rn Jobs in Bay Area

About The Position

Requirements

• Bachelor’s degree and 5 years work experience required or Associate degree with 7 years relevant work experience or High School diploma with 9 years relevant work experience required

Nice To Haves

• Five or more years work experience with state and federal agencies and/or commercial insurance payers
• Five or more years work experience in healthcare revenue cycle (prior authorization, coding, claims, denials, appeals, billing compliance, etc.)
• Advanced degree; MBA, JD, M.A. / M.S., CGC, RN
• Prior experience building strategic relationships
• Prior work experience in a clinical or business setting

Responsibilities

• Works directly with Segment Science and Marketing management teams to develop an understanding of existing and emerging technologies to provide education, appeals influence and insight pertaining to payer policy for Government and Commercial payers.
• Provide support to include attending Payer meetings with Payor Solutions Account Executives to communicate specific policy concerns and denials trends.
• Regularly monitors payer policy updates and changes such as NCD, LCD and other commercial insurance coverage policies impacting reimbursement.
• Functions as a liaison between Labcorp Sales, Medical Directors, and Government and Commercial Payer Medical Directors on issues pertaining to existing payer policies and proposed policy changes impacting reimbursement.
• Will assist the Manager(s) with subject matter expertise for the development of comments on regulatory proposals, written testimony, policy position papers and regulations that affect the company, analyzing public policy, legislative and regulatory proposals, and reporting internally as required.
• Collaborates with Sales and client accounts as a subject matter expert on payer policies and prior authorization requirements.
• Communicates developments and updates on a regular basis through periodic reporting mechanisms and appropriate internal and external communications channels.
• Examines health care trends, monitors implementation of Government Health Care Acts to inform business of implications and identify potential opportunities and/or risk for Medicare, Medicaid, Accountable Care Organizations, and Commercial payers.
• Evaluates laboratory-related state legislation and laws to engage subject matter experts to determine potential impacts and next steps.
• Develops and maintains key contacts within Labcorp’s Sales leadership and Payor Solutions leadership to collaboratively address and improve reimbursement for medically necessary testing performed.
• Performs other and further duties and responsibilities as shall be assigned by the manager, Director and/or Vice President of Payer Policy.
• Assisting the Manager of Payer Policy and Relations with policy and alliance development activities for the company, including assistance with development and implementation of policy strategies to support Labcorp and the laboratory industry at the state and federal levels.
• Act as internal conduit to gather and share information as it relates to policy, billing and reimbursement issues.
• Primarily focus on developing and implementing strategies to improve the outcomes of prior authorizations for genetic testing.

Benefits

• Medical
• Dental
• Vision
• Life
• STD/LTD
• 401(k)
• Paid Time Off (PTO) or Flexible Time Off (FTO)
• Tuition Reimbursement
• Employee Stock Purchase Plan