Payment Policy Research Analyst

Sentara Health · Maine, ME, United States

FULL TIME

Job Description

Work Shift

Payment Policy Research Analyst & Technical Writer is responsible for the identification, development & presentation of new policy-related medical cost savings opportunities on behalf of Sentara Health Plan (SHP). You will assess new opportunities based on data insights leveraging tools, policies, industry trends & by soliciting input from subject matter experts across SHP. You will work with internal & external business constituents to determine opportunities for growth w/in our core payment/reimbursement policies & be responsible for savings delivery through deployment.

Research & assessment of internal payment policies & payment solutions in relation to competitors & industry standards to identify new cost savings opportunities

Determine potential strategies &/or solutions to achieve identified cost savings such as policy development or enhancement, authorization criteria & process, contract strategy, claims editing & more

Establish strong relationships with internal & external stakeholders to define, align & deliver payment initiatives & new/enhanced policy development in support of health plan goals

High School Diploma or equivalent (Required)

Bachelor Level Degree (Preferred)

3 years Health plan experience or 3 years Medical coding, required

3 years Health plan claim auditing or appeals, preferred

BS/BA/Advanced degree in health care or medical field preferred

Remote Work Schedule Opportunity

Experience managing multiple concurrent projects & meet tight delivery timelines

Intermediate computer skills with Excel, PowerPoint & Outlook with minimal supervision:

Excel - Create spreadsheets, manipulate data & create pivot tables/reporting

Knowledge of statistical methods used in the evaluation of healthcare claims data

Professional & Institutional reimbursement experience includes coding certifications

Reimbursement policy &/or technical writing experience for development & publication

The base pay range for full-time employment is $105,560.00 - $162,552.00 annually. Additional compensation may be available for this role, such as shift differentials, on-call pay, shift premiums, extra-shift incentives, or bonus opportunities. Compensation within the range may vary based on qualifications, experience, location, market conditions, and business needs. Note: If an annual salary is posted, it is based on a full-time colleague working 2,080 hours annually.

Sentara offers a comprehensive benefits package, including medical, dental, vision, life and disability insurance; paid time off (vacation, sick time, and holidays); Medical, Dental, Vision plans

Adoption, Fertility and Surrogacy Reimbursement up to $10,000
Long-Term, Short-Term Disability, and Critical Illness plans
Life Insurance
Legal Resources Plan
Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

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Payment Policy Research Analyst

Job Description

Bachelor Level Degree (Preferred)

3 years Health plan experience or 3 years Medical coding, required

3 years Health plan claim auditing or appeals, preferred

BS/BA/Advanced degree in health care or medical field preferred

Sentara Health employs associates in the following states

Company	Sentara Health
Location	Maine, ME, United States
Type	FULL TIME
Niche	tech