[Hiring] Payment Policy Research Analyst @Sentara Health

Role Description

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 within 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.
• Participate in analytical, investigative & other fact-finding work in support of opportunity development.
• Establish strong relationships with internal & external stakeholders to define, align & deliver payment initiatives & new/enhanced policy development in support of health plan goals.
• Influence leadership to adopt new ideas, approaches &/or products.

Qualifications

• High School Diploma or equivalent (Required)
• Bachelor Level Degree (Preferred)
• Certificate of Professional Coder - CPC Certification (Required)
• 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)
• CPC required within first 6 months of hire

Requirements

• Experience presenting, collaborating & consulting with a variety of stakeholders or clients across multiple functional areas.
• Experience managing multiple concurrent projects & meet tight delivery timelines.
• Innovative thinker that works well in an ambiguous, growth environment.
• Intermediate computer skills with Excel, PowerPoint & Outlook with minimal supervision:
• Excel - Create spreadsheets, manipulate data & create pivot tables/reporting.
• PowerPoint - Create professional looking presentations.
• Outlook - Schedule meetings, coordination, task tracking.

Benefits

• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down – $10,000
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.