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 under the mentorship and guidance of a Senior Policy Analyst/Policy Lead. This hire must be organized, 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. This role presents an excellent opportunity to learn the basis of healthcare payment methodologies.
What you will do:
• Read and analyze Medicare data and policy including final rulings, 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 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 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.
What you bring:
- 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
• 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