Payment Policy Analyst

Yesterday

🇺🇸 United States – Remote

🦌 Connecticut – Remote

Although this job is listed in Connecticut, this company may be open to hiring remote in other states.

🐊 Florida – Remote

Although this job is listed in Florida, this company may be open to hiring remote in other states.

+3 more states

🦌 Connecticut – Remote 🐊 Florida – Remote 🗻 New Hampshire – Remote 🗽 New York – Remote 🌴 South Carolina – Remote

💵 $67.2k - $97.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

🦅 H1B Visa Sponsor

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10,000+ employees

Founded 1999

💰 $20M Series F on 2005-12

Description

• Facilitate the Healthfirst reimbursement and billing guidelines policy process, including developing new policies, monitoring industry reimbursement policy trends, and tracking annual renewals • Conduct industry/market research on New York Medicaid and CMS reimbursement methodologies to support creation of reimbursement and billing guidelines • Format reimbursement policies, collaborate with stakeholders, perform editorial review, check policy references, and obtain necessary approvals • Collaborate with the Regulatory, Compliance, Legal and key stakeholder departments to organize deliverables, prepare materials, and take minutes for committees • Prepare reports for the Reimbursement Operating Council (ROC) and any other applicable governance committees • Identify potential organizational risks and help facilitate process improvements • Review the appropriate reimbursement policies, billing procedures, and make recommendations for policy creation/revision and/or committee action • Build sustainable relationships of trust through open and interactive communication with cross-functional teams at all levels of management • Comply with HIPAA requirements and maintain Protected Health Information (PHI) confidentiality of member, provider, medical, and departmental information • Ensure adherence to local, state, federal, and Healthfirst specific compliance and regulatory guidelines and ensure a timely and accurate response to any requests for information or audits

Requirements

• Associate degree or equivalent work experience • Experience with creation of formal policy and procedures • Familiarity with reimbursement methodologies • Previous compliance experience within a managed care environment • Familiarity with reimbursement terminology • Knowledge of CMS and/or New York State DOH reimbursement methodologies • Experience working in a fast-paced environment that requires adapting to change while handling multiple priorities simultaneously • Work experience requiring effective communication verbally and in writing while demonstrating good grammar, spelling, and punctuation skills

Benefits

• medical, dental and vision coverage • incentive and recognition programs • life insurance • 401k contributions