Sr. Payer Policy Relations Analyst-Oncology -HYBRID (Medical Review-Appeals)
About the position
Responsibilities
• Works directly with Oncology Segment Marketing Management teams to develop an understanding of existing and emerging technologies to provide education, appeals influence and insight pertaining to payer policy.
• Manage informational needs of multiple cross functional stakeholders regarding payer coverage and reimbursement policy issues and/or changes.
• Serve as a point of contact within RCM Payer Policy & Relations Team for payer information, payer communication and issue identification.
• Responsible for making recommendations to management and may initiate implementation of new procedures and processes related to appeals strategies.
• Facilitate resolution of oncology coverage and reimbursement issues between Payers, Government agencies and LabCorp.
• Extrapolate and summarize essential medical information for review, identifying denial trends by case type and payer-specific issues.
• Work with Policy Reporter data to understand changes in payer policy impacting reimbursement.
• Collaborate with other departments/business associates to analyze, understand, and define business rules for oncology policy changes.
• Collaborate with Prior Authorization teams to deploy best practices to support reimbursement capture.
• Apply critical reasoning to assess the need for formal appeal of clinical denials and collaborate with stakeholders to draft templates for customized appeals by tumor types.
• Exceptional writing skills to develop effective strategies for oncology denials to include supportive clinical evidence, complying with all clinical and billing policies, guidelines and regulations.
• Conduct clinical evidence searches, utilize internal and external subject matter experts and/or other avenues of research to identify supportive evidence for coverage of oncology services.
• Effectively communicate developments and updates on a regular basis through periodic reporting mechanisms and appropriate internal and external communication channels.
• Maintain a thorough knowledge of regulatory processes and policy developments on matters affecting Oncology.
• Develop and maintain key contacts and relationships with policy makers for Medicare contractors, Medicaid payers and Commercial insurers.
• Support 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.
• Perform other and further duties and responsibilities as assigned.
• Position may require travel (up to 20%) to meet face-to-face with payers, industry leaders, and LabCorp Oncology and RCM business units.
Requirements
• Minimum Years of Experience: 5+ years of relevant work experience in a clinical and business setting
• Strong preference given to Advanced degree; MBA, JD, M.A. / M.S., CGC, RN
• Previous Oncology work experience
• 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.).
Benefits
• Medical
• Dental
• Vision
• Life
• STD/LTD
• 401(K)
• ESPP
• Paid time off (PTO) or Flexible time off (FTO)
• Commissions
• Company bonus where applicable
Apply Now
Apply Now
Responsibilities
• Works directly with Oncology Segment Marketing Management teams to develop an understanding of existing and emerging technologies to provide education, appeals influence and insight pertaining to payer policy.
• Manage informational needs of multiple cross functional stakeholders regarding payer coverage and reimbursement policy issues and/or changes.
• Serve as a point of contact within RCM Payer Policy & Relations Team for payer information, payer communication and issue identification.
• Responsible for making recommendations to management and may initiate implementation of new procedures and processes related to appeals strategies.
• Facilitate resolution of oncology coverage and reimbursement issues between Payers, Government agencies and LabCorp.
• Extrapolate and summarize essential medical information for review, identifying denial trends by case type and payer-specific issues.
• Work with Policy Reporter data to understand changes in payer policy impacting reimbursement.
• Collaborate with other departments/business associates to analyze, understand, and define business rules for oncology policy changes.
• Collaborate with Prior Authorization teams to deploy best practices to support reimbursement capture.
• Apply critical reasoning to assess the need for formal appeal of clinical denials and collaborate with stakeholders to draft templates for customized appeals by tumor types.
• Exceptional writing skills to develop effective strategies for oncology denials to include supportive clinical evidence, complying with all clinical and billing policies, guidelines and regulations.
• Conduct clinical evidence searches, utilize internal and external subject matter experts and/or other avenues of research to identify supportive evidence for coverage of oncology services.
• Effectively communicate developments and updates on a regular basis through periodic reporting mechanisms and appropriate internal and external communication channels.
• Maintain a thorough knowledge of regulatory processes and policy developments on matters affecting Oncology.
• Develop and maintain key contacts and relationships with policy makers for Medicare contractors, Medicaid payers and Commercial insurers.
• Support 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.
• Perform other and further duties and responsibilities as assigned.
• Position may require travel (up to 20%) to meet face-to-face with payers, industry leaders, and LabCorp Oncology and RCM business units.
Requirements
• Minimum Years of Experience: 5+ years of relevant work experience in a clinical and business setting
• Strong preference given to Advanced degree; MBA, JD, M.A. / M.S., CGC, RN
• Previous Oncology work experience
• 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.).
Benefits
• Medical
• Dental
• Vision
• Life
• STD/LTD
• 401(K)
• ESPP
• Paid time off (PTO) or Flexible time off (FTO)
• Commissions
• Company bonus where applicable
Apply Now
Apply Now