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The incumbent serves as a State Government Programs Policy Analyst to research and analyze Medicaid fee-for-service and Medicaid managed care organization and other state government program payer regulations, coverage, coding, pricing, and payment policies. The incumbent ensures compliance with payer regulations by working cross-functionally to align internal processes. The incumbent has excellent research, analysis, and project management skills, and the ability to work cross-functionally with the operations teams. The incumbent has exceptional oral and written communication skills.
Job Responsibility:
Conduct analysis of state government programs policy impacting Respiratory Health products
Monitor and interpret state and payer documentation, including but not limited to provider manuals, guidelines, bulletins, and regulatory communications
Develop and maintain relationships with managed care organizations to ensure compliance with payer policy and regulations
Develop strategic policy summaries to inform leadership decisions
Track and analyze legislative and regulatory developments affecting Respiratory Health products within the State Government Programs space
Translate policy requirements into actionable operational guidance and workflows maintaining compliance with payer policy and regulations
Identify compliance risks associated with payer changes and recommend mitigation strategies to State Government Programs Manager
Requirements:
Two-year associates degree required or Bachelor's degree (B.A. or B.S.) from four-year college or university preferred
Minimum 4 years of relevant work experience in healthcare reimbursement, payer policy and/or health plan administration
Working knowledge of state government program policy including Medicaid fee-for-service, Medicaid managed care organizations, disability waivers, Children’s Health Insurance Programs (CHIP), and other state government programs preferred
General understanding of provider credentialing and enrollment requirements preferred
General knowledge of TIMS third party payer database and state and federal laws, rules, and regulations preferred
Strong knowledge of database integrity procedures and standards and ability to apply analytical findings to day-to-day business practices preferred
Ability to lead projects, meet deadlines, and prioritize workload
Superior communication, innovative, and critical thinking skills
Nice to have:
Working knowledge of state government program policy including Medicaid fee-for-service, Medicaid managed care organizations, disability waivers, Children’s Health Insurance Programs (CHIP), and other state government programs
General understanding of provider credentialing and enrollment requirements
General knowledge of TIMS third party payer database and state and federal laws, rules, and regulations
Strong knowledge of database integrity procedures and standards and ability to apply analytical findings to day-to-day business practices
What we offer:
medical and dental coverage that start on day one
insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
Employee Stock Purchase Plan (ESPP), with the ability to purchase company stock at a discount
401(k) Retirement Savings Plan (RSP), with options for employee contributions and company matching
Flexible Spending Accounts
educational assistance programs
paid holidays
paid time off ranging from 20 to 35 days based on length of service