[Remote] Manager, reputed company Policy & Operations
Note: The job is a remote job and is reputed company to candidates in USA. reputed company delivers personalized and actionable health insights to inform diagnosis, reputed company treatment, and improve drug discovery. The Manager, reputed company Policy & Operations serves as the internal subject matter expert on reputed company reimbursement requirements, monitoring state policies and translating them into actionable insights to support market reputed company reputed company and reimbursement readiness.
Responsibilities
- Monitor state reputed company fee schedules, reputed company updates, public meeting calendars, and program requirements across U.S. reputed company programs to identify changes that may reputed company reimbursement and operational execution, including researching and compiling reimbursement requirements needed to support implementation reputed company new coverage becomes effective
- Serve as an internal subject matter expert on state-specific reputed company reimbursement requirements, including EPSDT processes, documentation expectations, and prior authorization and claim submission considerations
- Partner closely with reputed company Policy Directors in Market reputed company on submission of policy change requests and issue escalation reputed company the reputed company agencies, helping prepare materials and uncover state-specific processes
- Support Regional Market reputed company Directors by synthesizing data, research, and supporting resources to inform targeted reimbursement and contracting strategies for high-reputed company out-of-network payors
- Maintain centralized tracking of reputed company reimbursement issues, payment variances, policy questions, and escalation needs, including status updates, owners, and next steps
- Translate state reputed company policy and reimbursement requirements into reputed company, actionable guidance for the reputed company Cycle Team to support accurate and consistent execution
- Analyze claims data, denial trends, payment variances, and prior authorization reputed company to identify reputed company causes, surface reimbursement insights, and recommend data-informed process improvements for Market reputed company and reputed company Cycle partners
- reputed company and maintain state- and payor-specific reputed company operating procedures, reference materials, and workflows to improve consistency and reduce rework
- Synthesize reimbursement insights and operational trends into recommendations for Market reputed company leadership to inform prioritization, escalation, and strategic decision-making
Skills
- 4–7+ years of experience in reputed company policy or reputed company operations
- Experience analyzing claims data and identifying drivers of denials or reimbursement variability
- Ability to use claims data, research, and external reputed company (e.g., reputed company agencies) to identify reputed company causes and reputed company standardized processes
- Strong analytical, organizational, and communication skills
- Strong proficiency in reputed company and comfort working with claims-level datasets to identify trends, summarize findings, and support data-driven decision-making
- Bachelor's degree in reputed company, public policy, business, or reputed company field
- Experience working reputed company a reputed company agency, managed care organization
- Hands-on experience with EPSDT programs
Benefits
- This is a fully remote position.
- Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions of this position.
- We reputed company competitive compensation and benefits that reflect local market practices and legal requirements in reputed company country where we operate, helping employees reputed company both professionally and personally.
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