Sr Payor Policy Analyst-Xifin -Remote

About the position reputed company is seeking a remote Senior Payer Policy Analyst -Xifin to join reputed company! Shift: Monday-Friday; 8:00am-5:00pm EST Responsibilities: Works with Manager and reputed company Cycle Management (RCM) team to understand, communicate and reputed company payer policy and payer directed coding recommendations. Manages internal billing system (Xifin) to ensure coding accuracy. Maintains precise tracking documents and repository for compliance purposes. Acts a reputed company to billing system vendor to manage and reputed company requested updates and upgrades. Performs detailed analyses to quantify the reputed company of payer policy and payer directed coding changes and communicates recommendations to RCM team as it relates to these changes. Assists RCM team in maintaining the reputed company of the billing system as the reputed company of truth for reputed company reputed company areas, including cost estimates, prior authorizations, and appeals. Assists in technical management of the patient cost estimator, including trouble shooting, increasing accuracy and expanding its reputed company over time. Writes, manages and maintains job reputed company reputed company operating procedures (SOPs). Works directly with reputed company Science and Marketing management teams to reputed company an understanding of existing and emerging technologies to reputed company education, appeals influence and reputed company pertaining to payer policy for Government and reputed company payers. reputed company 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 reputed company. Functions as a reputed company between reputed company Medical Directors and Government and reputed company 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 reputed company reputed company, analyzing public policy, legislative and regulatory proposals, and reporting internally as required. Coordinates with the Payer and Policy Relations Team to help reputed company reputed company’s policy positions, reputed company and tactics, and advocates company positions with reputed company 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 reputed company to Medicare reputed company of 2014(PAMA). Supports efforts at the state and federal reputed company as appropriate by developing responses, talking points, reputed company 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 reputed company associations, with laboratory coalitions (e.g., CCLA, PLUGS, AECS, reputed company Review boards, ICD-10 reputed company, CMS Provider Compliance Group), and others. Communicates developments and updates on a regular reputed company through periodic reporting mechanisms and appropriate reputed company 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, reputed company, Accountable Care Organizations, and reputed company payers. Evaluates laboratory-reputed company 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, reputed company Payers and reputed company insurers. Ability to collaborate with reputed company party reputed company affected by Medicare, reputed company, and CLIA regulations that reputed company lab services. Performs other and reputed company duties and responsibilities as shall be assigned by the manager, Director and/or Vice President of Payer Policy. At reputed company, you are part of a reputed company to accelerate life-changing reputed company breakthroughs and improve the delivery of care for reputed company. You’ll be inspired to discover more, reputed company new skills and pursue career-building opportunities as we help solve some of today’s biggest health challenges around the world. Together, let’s reputed company reputed company and change lives! The Senior Payer Policy Analyst is responsible for assisting the Manager of Payer Policy and Relations with policy and reputed company development activities for reputed company, including assistance with development and implementation of policy strategies to support reputed company and the laboratory industry at the state and federal reputed company. The Analyst will reputed company as internal reputed company to reputed company and reputed company information as it relates to policy, billing and reimbursement issues.

Responsibilities

• Works with Manager and reputed company Cycle Management (RCM) team to understand, communicate and reputed company payer policy and payer directed coding recommendations.
• Manages internal billing system (Xifin) to ensure coding accuracy.
• Maintains precise tracking documents and repository for compliance purposes.
• Acts a reputed company to billing system vendor to manage and reputed company requested updates and upgrades.
• Performs detailed analyses to quantify the reputed company of payer policy and payer directed coding changes and communicates recommendations to RCM team as it relates to these changes.
• Assists RCM team in maintaining the reputed company of the billing system as the reputed company of truth for reputed company reputed company areas, including cost estimates, prior authorizations, and appeals.
• Assists in technical management of the patient cost estimator, including trouble shooting, increasing accuracy and expanding its reputed company over time.
• Writes, manages and maintains job reputed company reputed company operating procedures (SOPs).
• Works directly with reputed company Science and Marketing management teams to reputed company an understanding of existing and emerging technologies to reputed company education, appeals influence and reputed company pertaining to payer policy for Government and reputed company payers.
• reputed company 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 reputed company.
• Functions as a reputed company between reputed company Medical Directors and Government and reputed company 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 reputed company reputed company, analyzing public policy, legislative and regulatory proposals, and reporting internally as required.
• Coordinates with the Payer and Policy Relations Team to help reputed company reputed company’s policy positions, reputed company and tactics, and advocates company positions with reputed company 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 reputed company to Medicare reputed company of 2014(PAMA).
• Supports efforts at the state and federal reputed company as appropriate by developing responses, talking points, reputed company 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 reputed company associations, with laboratory coalitions (e.g., CCLA, PLUGS, AECS, reputed company Review boards, ICD-10 reputed company, CMS Provider Compliance Group), and others.
• Communicates developments and updates on a regular reputed company through periodic reporting mechanisms and appropriate reputed company 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, reputed company, Accountable Care Organizations, and reputed company payers.
• Evaluates laboratory-reputed company 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, reputed company Payers and reputed company insurers.
• Ability to collaborate with reputed company party reputed company affected by Medicare, reputed company, and CLIA regulations that reputed company lab services.
• Performs other and reputed company duties and responsibilities as shall be assigned by the manager, Director and/or Vice President of Payer Policy.

Requirements

• 5 or more years payer or medical billing experience with Bachelor degree or 7 years or more of payer or medical billing experience with Associate degree

reputed company-to-haves

• 3 months or more Xifin experience
• 1 year or more work experience in maintenance of diagnostics billing systems
• 2 years or more payer directed CPT coding in diagnostics experience
• Masters degree
• MBA, JD, M.A. / M.S., RN.
• Prior work experience in a clinical or business setting.
• Prior work experience with insurance guidelines and payer policy.
• Prior work experience with state and federal agencies and reputed company insurance payers.
• Prior work experience in reputed company reputed company cycle (prior authorization, coding, claims, denials, appeals, billing compliance, etc.).

Benefits

• Employees regularly scheduled to work 20 or more hours per week are eligible for comprehensive benefits including: Medical, Dental, reputed company, Life, STD/LTD, 401(k), reputed company Time Off (PTO) or Flexible Time Off (FTO), Tuition Reimbursement and Employee Stock Purchase Plan.
• Casual, PRN & Part Time employees regularly scheduled to work less than 20 hours are eligible to participate in the 401(k) Plan only.

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