Payment Policy Analyst

Yesterday

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HealthEdge

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HealthEdge is a company that specializes in providing advanced solutions for healthcare payers through its HealthRules Solutions Suite. This suite includes a comprehensive digital claims administration processing system, care management workflow solutions, and payment integrity solutions, which aim to enhance operational efficiency and improve quality of care for health plans. By leveraging integrated technology and automation, HealthEdge helps health plans eliminate data silos, increase payment accuracy, and elevate member experience, thereby transforming the healthcare landscape for better collaboration and accessibility.

Healthcare Technology

1001 - 5000 employees

Founded 2005

⚕️ Healthcare Insurance

☁️ SaaS

💳 Fintech

📋 Description

• The Payment Policy Analyst I functions as an internal subject matter expert and works closely with cross functional team members in Medicare/Medicaid reimbursement methodologies, laws and regulations. • Organize and possess good communication and writing skills, and have impeccable attention to detail in order to meet assigned deliverables prior to the end of sprint cycles. • The ideal candidate will be a true team player who is flexible to lend a hand on other projects as needed. • Excellent opportunity to learn the basis of healthcare payment methodologies. • Read and analyze Medicare/Medicaid data and policy, including proposed and final rules, daily transmittals, bulletins, policy manual updates, physician fee schedule (data file). • Contact various government entities to clarify new and existing policy. • Interpret and deliver business requirements covering reimbursement updates and payment policy changes and enhancement features for translation into software design specifications. • Create detailed and accurate Excel formulas to explain and prove complex payment methodologies. • Coordinate with developers, QA, data, client service and other team members to ensure that business requirements are implemented accurately and timely. • Develop accurate and comprehensive test claims for Developers, UAT and QA. • Develop and maintain proficiency in the Company’s products (software, data) and services, including commercial contracting features as related to the specific area(s) assigned. • Become familiar in assigned Provider Payment Systems like APC, DRG, RBRVS.

🎯 Requirements

• Bachelor’s degree in a healthcare or comparable field. • 1-3 years professional experience in healthcare, and working knowledge of health care reimbursement systems and methodologies. • Ability to effectively communicate and collaborate with diverse internal and external stakeholder groups and individuals. • Ability to collect, research, and understand diverse information, and translate it into clear and concise written requirements. • Ability to plan, prioritize, and balance the need for direction with self-motivated efforts. • Strong interpersonal skills. • Bonus Points: • Experience in an agile systems development life cycle (SDLC) environment. • Experience using MS Office (Word, Excel, PowerPoint, Visio, Access) software applications. • Experience using various Web-based and other research sources and tools.