Health Policy Analyst Jobs

WFH Flexible

• San Diego, CA (http://maps.google.com/maps?q=5471+Kearny+Villa+Road+San+Diego+CA+92123)

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Description

SUMMARY

Under the supervision of the Senior Manager of Contracts and Credentialing the Health Policy Analyst will be responsible for accurate representation of all medical policies and identify any potential changes to existing medical policies. This role will be critical to ensuring all payer updates are effectively communicated throughout the organization. The Health Policy Analyst will have a strong understanding of the payor reimbursement schedules, and all fee schedules.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Prepares documentation and reviews as needed with the Sr. Manager and Director.
• Maintains all medical rule editorials in the appropriate Medical Policy files in efforts to create programmatic tools with ability to research and analyze data
• Responsible for Medicare certification/enrollment and maintaining enrollment requirements
• Identify necessary and potential changes to existing medical policies through review of current and historically available medical policies, transmittals, and bulletins. This includes but is not limited to revision and retirement of existing policies and the addition of new policies
• Responsible for timely and accurate research of resources that update critical information on a scheduled basis. Stay abreast of all payor updates as puritans to the management of Sleep Apnea
• Responsible for the accurate representation of medical policies/edits/updates from any payer source
• Must have high standards with extreme attention detail
• Extracts information from resources and translates information needed to form appropriate logic for rules. Also responsible for documentation and Quality Assurance review. Complete and review integrity checks with payor contracts as these edits are used, or modified to support the business
• Responds to Quarterly updates with contracted payers per guidelines, creates and manages workflow, ensure the Contracted insurance directories are current
• Must be able to exercise independent judgment
• Completes review of medical policies and publications and its integration into the required organizational files on a timely basis
• Responsible for Medicaid certification/enrollment and maintaining enrollment requirements
• Present all payer updates to the organization and ensure updates are facilitated and communicated throughout the organization with the end goal of the Operations division taking the necessary actions to support updates
• Regulatory liaison between the Contracting and Credentialing department and all other Operations departments in the organization
• Responsible for appropriate documentation in respective software programs, Evisort and Modio as applicable
• Build, utilize, and understand Medicare fee schedules, payor reimbursement schedules, fee schedules, building, manages the Internal Benefit calculator on a quarterly basis, interacting with all internal and external clients as pertains to Health Policy updates and Compliance Support Issues identified
• Ability to maintain effective working relationships is essential
• Reviews forwarded Technical Support information/documentation for completeness and accuracy Composes responses and discusses with all appropriate internal departments as necessary

Requirements

• High School Diploma or General Education Development (GED) required.
• Minimum of five (5) years of experience in healthcare required, preferably in DME and or professional sleep medicine specialty?environment.
• Must be proficient in using Microsoft suite -Excel, including creating spreadsheets, MS office, PowerPoint presentation, and general computer skills.
• Must have knowledge of Medical Terminology as pertains to Sleep Medicine, general knowledge of anatomy and physiology, and knowledge of Medicare reimbursement guidelines.
• Must have one of the following certifications: Certified Provider Credentialing Specialist through NAMSS and/or Registered Health Information Technology (RHIT) through American Health Information Management Association
• An Associate’s or Bachelor’s degree in the Life Sciences is preferred Bachelor’s degree or three (3) years of experience in a directly related field preferred.

BetterNight is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with contractor's legal duty to furnish information. 4I CFR 60-I.35(C).

Salary Description

$27.00 - $32.00 / hr