Senior Payer Policy Analyst

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Support the Manager of Payer Policy and Relations in the development of policies and alliances.

• Assist in formulating and executing policy strategies that benefit Labcorp and the laboratory sector at both state and federal levels.

• Act as an internal resource by collecting and disseminating information on policy, billing, and reimbursement matters.

• Establish connections with state Medicaid representatives to enhance reimbursement for genetic testing services.

• Collaborate with Segment Science and Marketing management teams to gain insights on current and upcoming technologies, while providing education, influencing appeals, and offering payer-policy analysis.

• Participate in payer meetings alongside Payor Solutions Account Executives to express policy issues and trends in denials.

• Keep track of updates and modifications in payer policies, including NCD, LCD, and other coverage policies that affect revenue.

• Serve as a liaison between Labcorp Medical Directors and Government as well as Commercial Payer Medical Directors regarding ongoing and proposed payer policies.

• Contribute to regulatory comments, written testimonies, policy position papers, and analysis of public policy, legislative, and regulatory proposals.

• Assist in formulating policy positions, strategies, and approaches, advocating for the company's stance on legislation, regulations, and public policy.

• Support initiatives addressing price erosion in Medicare and private-sector payers due to PAMA.

• Develop responses, talking points, and strategies concerning significant state and federal issues.

• Advocate for the company's positions during meetings with trade associations, professional groups, laboratory coalitions, Medicaid Review boards, and other stakeholders.

• Communicate updates and developments through regular reports and various internal and external communication channels.

• Analyze healthcare trends and monitor the implementation of Government Health Care Acts to identify business implications, opportunities, and risks.

• Review laboratory-related state legislation and laws, engaging subject matter experts to assess impacts and determine next steps.

• Draft language based on state regulations to appeal claim denials and pursue reimbursement from payers.

• Build and nurture relationships with policymakers for Medicare Contractors, Medicaid Payers, and Commercial insurers.

• Collaborate with third-party organizations affected by Medicare, Medicaid, and CLIA regulations related to laboratory services.

• Execute additional responsibilities as assigned by the Manager, Director, and/or Vice President of Payer Policy.

⛳️ Requirements

• A Bachelor's degree with a minimum of 5 years of relevant work experience is required; if no degree, at least 7 years of work experience is necessary.

• An advanced degree such as an MBA, JD, M.A. / M.S., CGC, or RN is preferred.

• Proficiency in Microsoft Suite with at least Intermediate Excel skills (including pivot tables and VLOOKUPs) is preferred.

• A minimum of 3 years of experience in establishing State Medicaid relationships and securing reimbursements for genetic testing is preferred.

• At least 5 years of experience in a clinical or business environment is preferred.

• A minimum of 3 years of familiarity with insurance guidelines and payer policies is preferred.

• At least 3 years of experience dealing with state and federal agencies and commercial insurance payers is preferred.

• A minimum of 3 years of experience in healthcare revenue cycle management, covering prior authorization, coding, claims, denials, appeals, and billing compliance is preferred.

• Excellent written, verbal, and presentation skills are essential.

• The ability to convey complex information clearly and concisely to individuals at all organizational levels is required.

• Capacity to work independently while managing multiple projects simultaneously is necessary.

• Experience in taking ownership of issues and providing practical solutions is preferred.

• Aptitude for prioritizing and handling mission-critical tasks in a dynamic environment is essential.

🏝️ Benefits

• Medical insurance

• Dental insurance

• Vision insurance

• Life insurance

• Short-term disability (STD)

• Long-term disability (LTD)

• 401(k) Plan

• Paid Time Off (PTO) or Flexible Time Off (FTO)

• Tuition Reimbursement

• Employee Stock Purchase Plan