Sr Payer Policy Analyst

Sr Payer Policy Analyst

Requirements

• Bachelor’s degree from an accredited four-year institution and 5 years work experience required (If no degree- minimum 7 years work experience required).

Responsibilities

• Works directly with Segment Science and Marketing management teams to develop an understanding of existing and emerging technologies to provide education, appeals influence and insight pertaining to payer policy for Government and Commercial payers.
• Provide support to include attending Payer meetings with Payor Solutions Account Executives to communicate specific policy concerns and denials trends.
• Regularly monitors payer policy updates and changes such as NCD, LCD and other coverage policies impacting revenue.
• Functions as a liaison between LabCorp Medical Directors and Government and Commercial Payer Medical Directors on issues pertaining to existing payer policies and proposed policy changes impacting reimbursement.
• Will assist the Manager with subject matter expertise for the development of comments on regulatory proposals, written testimony, policy position papers and regulations that affect the company, analyzing public policy, legislative and regulatory proposals, and reporting internally as required.
• Coordinates with the Payer and Policy Relations Team to help develop LabCorp’s policy positions, strategy and tactics, and advocates company positions with regard to new or amended legislation, regulations, or public policy. Helps support efforts in defending against risk of Medicare and private sector payer price erosion associated with the Protecting Access to Medicare Act of 2014(PAMA).
• Supports efforts at the state and federal levels as appropriate by developing responses, talking points, strategy on key issues while helping to assure policy consistency across the organization.
• Assists in advocating company positions orally and in writing before, during and after meetings at ACLA (the clinical laboratory trade association), with other trade and professional associations, with laboratory coalitions (e.g., CCLA, PLUGS, AECS, Medicaid Review boards, ICD-10 coalition, CMS Provider Compliance Group), and others.
• Communicates developments and updates on a regular basis through periodic reporting mechanisms and appropriate internal and external communications channels.
• Examines health care trends, monitors implementation of Government Health Care Acts to inform business of implications and identify potential opportunities and/or risk for Medicare, Medicaid, Accountable Care Organizations, and Commercial payers.
• Evaluates laboratory-related state legislation and laws to engage subject matter experts to determine potential impacts and next steps.
• Crafts language based on state laws to assist in appealing claim denials and pursue payer reimbursement.
• Develops and maintains key contacts and relationships with policy makers for Medicare Contractors, Medicaid Payers and Commercial insurers. Ability to collaborate with third party groups affected by Medicare, Medicaid, and CLIA regulations that impact lab services.
• Performs other and further duties and responsibilities as shall be assigned by the manager, Director and/or Vice President of Payer Policy.

Preferred Qualifications

• Advanced degree ; MBA, JD, M.A. / M.S., CGC, RN
• Prior Genetic Counseling work experience
• Prior work experience in a clinical or business setting.
• Prior work experience with insurance guidelines and payer policy.
• Familiarity with clinical practice guidelines of national organizations such as NCCN, ACMG, ACC and AHA.
• Prior work in case reviews for medical necessity.
• Prior work experience with state and federal agencies and commercial insurance payers.
• Prior work experience in healthcare revenue cycle (prior authorization, coding, claims, denials, appeals, billing compliance, etc.).