Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.
Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.
The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time).
Pay Range:
$60,881.60 - $79,560.00Scheduled Weekly Hours:
40Position Overview
The Payor Policy Analyst Assists contract management with payor policy review, including assistance with development and implementation of strategies to support reimbursement at the state and federal levels. The Analyst is responsible for gathering and sharing information as it relates to policy, authorization, billing and reimbursement issues. Assessing payor policies to determine how they impact Capital Health revenue cycle, quality, patient satisfaction, patient access and other operational areas.
MINIMUM REQUIREMENTS
Education: High School degree or equivalent. Bachelor’s degree preferred.
Experience: Five years of experience in healthcare revenue cycle required. Professional and hospital revenue cycle experience and exposure to policy interpretation and/or contracting preferred.
Other Credentials:
Knowledge and Skills: Outstanding organizational skills and ability to summarize significant amounts of data in a meaningful way to communicate to various teams. Excellent verbal and written communication skills. Can work well independently and in team settings.
Special Training: Proficient in Microsoft Office.
Mental, Behavioral and Emotional Abilities:
Usual Work Day: 8 Hours
Reporting Relationships
Does this position formally supervise employees? No
If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager.
ESSENTIAL FUNCTIONS
Reviews and assesses new and existing payor policies for contracted Governmental, Commercial, and other third-party insurance carriers to assess impact on hospital and professional reimbursement, operations, revenue cycle service, quality, and patient satisfaction.
Maintains a proactive schedule for data gathering and review for upcoming changes and/or potential changes to payor policies and proposes strategic solutions to Capital Health leadership.
Assesses whether policies are following all state and federal regulations, especially Medicare and Medicaid requirements, finds variances with documented evidence, and escalates to Capital Health leadership for next steps (including but not limited to Revenue Cycle, Compliance, Operations, and Finance).
Supports efforts at the state and federal levels as appropriate by developing responses, talking points, and strategy on key issues while helping to ensure policy consistency across the organization.
Stays up to date with OIG, OAG, CMS, DHHS, and other state regulatory bodies for potential Federal and State changes in policies that will affect Capital Health.
Examines health care trends, monitors implementation of Government Health Care Acts to identify implications and potential opportunities and/or risk for Medicare, Medicaid and Commercial payors.
Interacts with industry groups to assess hospital market response, best practices, and reaction to policies.
Evaluates impact of policy changes and crafts compelling rebuttals to respond to health plans.
Creates analysis, assesses financial and operational impact of new policies, and provides a summary to the leadership team.
Creates draft objection letters for all payor policy changes that result in a significant financial impact.
Tracks, monitors, and assures Capital Health responds to payors based on policy matters.
Compares contract changes with health plan medical policies to identify if they are consistent.
Interacts and fosters relationships with DOH and other industry agencies to address concerns regarding payor policies.
Provides support to include attending Payor Relation meetings with Executive leadership to communicate specific policy concerns and denials trends.
Helps create, organize, and document communication surrounding policy updates, revisions, prior and post change to education and satisfy the needs of various departments and staff levels.
Performs additional duties to support team goals and company initiatives as needed.
PHYSICAL DEMANDS AND WORK ENVIRONMENT
Frequent physical demands include: Sitting
Occasional physical demands include: Standing , Walking , Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl , Wrist position deviation , Pinching/fine motor activities , Keyboard use/repetitive motion
Continuous physical demands include: Talk or Hear
Lifting Floor to Waist 15 lbs. Lifting Waist Level and Above 10 lbs.
Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Color Discrimination, Minimal Depth Perception, Moderate Hearing
Anticipated Occupational Exposure Risks Include the following: Dust/Particulate Matter
This position is eligible for the following benefits:
Medical Plan
Prescription drug coverage & In-House Employee Pharmacy
Dental Plan
Vision Plan
Flexible Spending Account (FSA)
- Healthcare FSA
- Dependent Care FSA
Retirement Savings and Investment Plan
Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance
Supplemental Group Term Life & Accidental Death & Dismemberment Insurance
Disability Benefits – Long Term Disability (LTD)
Disability Benefits – Short Term Disability (STD)
Employee Assistance Program
Commuter Transit
Commuter Parking
Supplemental Life Insurance
- Voluntary Life Spouse
- Voluntary Life Employee
- Voluntary Life Child
Voluntary Legal Services
Voluntary Accident, Critical Illness and Hospital Indemnity Insurance
Voluntary Identity Theft Insurance
Voluntary Pet Insurance
Paid Time-Off Program
The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level.
The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.