Payment Policy Research Analyst
Sentara Health
Summary
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 w/in our core payment/reimbursement policies & be responsible for savings delivery through deployment.
Job description
Primary Responsibilities
- 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
Education
- High School Diploma or equivalent (Required)
- Bachelor Level Degree (Preferred)
Certification/Licensure
- Certificate of Professional Coder- CPC Certification (Required)
Experience
- 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
- Remote Work Schedule Opportunity
Qualified Candidates will possess
- 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
Preferred
- Knowledge of statistical methods used in the evaluation of healthcare claims data
- Professional & Institutional reimbursement experience includes coding certifications
- Reimbursement policy &/or technical writing experience for development & publication
Requirements
- High School Diploma or equivalent (Required)
- Certificate of Professional Coder- CPC Certification (Required)
- 3 years Health plan experience or 3 years Medical coding, required
- 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
Benefits
- Medical, Dental & Vision
- 401(k) Matching
- Paid Time Off
- Paid Parental Leave
- Paid Military Leave
- Educational Assistance
- Student Loan Repayment
- Adoption Reimbursement
- Fertility Reimbursement
- Surrogacy Reimbursement
- Emergency Backup Care
- Pet Insurance
- Legal Resources Plan
- Annual Discretionary Bonus
Company overview
Sentara Health is a leading not-for-profit integrated healthcare delivery system serving Virginia, northeastern North Carolina, and Florida. Founded in 1888 and headquartered in Hampton Roads, Virginia, Sentara operates 12 acute care hospitals across its service area, with 10 hospitals holding prestigious Magnet® recognition for nursing excellence. The organization employs approximately 34,000 healthcare professionals and serves over 1 million health plan members through its Sentara Health Plans division. As one of the top 20 largest not-for-profit integrated health systems in the United States, Sentara is nationally recognized for clinical quality, safety, and innovation. The system has received numerous accolades including Health Quality Innovator of the Year (2024), Forbes' "America's Best-In-State Employer" (2024), and inclusion in IBM Watson Health's "Top 15 Health Systems." Sentara's comprehensive services span hospital care, outpatient facilities, home health, hospice services, and specialized programs like the Nightingale air ambulance service, which has completed over 20,000 missions since 1982.