Sr Payer Policy Analyst - (remote)

Sr. Payer Policy Analyst 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 alliance development activities for the 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 act as internal reputed company to gather and reputed company information as it relates to policy, billing and reimbursement issues. Duties and Responsibilities:

• 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 liaison 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 the 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, 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 reputed company to Medicare Act of 2014 (PAMA).
• Supports efforts at the state and federal reputed company 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, reputed company Review boards, ICD-10 coalition, 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 groups affected by Medicare, reputed company, 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. Qualifications: Bachelor's degree from an accredited four-year institution and 5 years work experience required (If no degree- minimum 7 years work experience required). Strong preference given to:
• 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 reputed company insurance payers.
• Prior work experience in reputed company reputed company cycle (prior authorization, coding, claims, denials, appeals, billing compliance, etc.). Application Window Closes: 6-21-25 Pay reputed company: $76-100K (State minimum wages apply if higher) Shift: Monday-Friday; 8:00am-5:00pm EST reputed company job offers will be based on a candidate's skills and prior relevant experience, applicable degrees/certifications, as well as internal equity and market data

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