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Clinical Payer Policy Analyst
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Job Description
- Req#: 744000073100985
Employer Industry: Precision Oncology
Why consider this job opportunity:
- Salary up to $89,420
- Opportunity for career advancement and growth within the organization
- Flexible hybrid work model with defined in-office days and remote work options
- Supportive and collaborative work environment focused on innovation in patient care
- Chance to influence payer policies and improve patient access to vital diagnostics
What to Expect (Job Responsibilities):
- Review and interpret complex clinical records related to payer policies, including Medicare and Medicaid
- Analyze coverage data to inform strategic objectives and support payer negotiations
- Collaborate with appeals teams to evaluate outcomes and craft compelling rebuttals
- Assist the Senior Manager with external appeals, liaising with IROs and regulatory agencies
- Stay informed on regulatory developments and policy changes impacting specialty testing and NGS reimbursement
What is Required (Qualifications):
- 2+ years of experience in healthcare reimbursement, clinical review, or claims management
- Strong understanding of billing, reimbursement, and regulatory processes
- Proficiency with clinical documentation, appeal writing, and denials management
- Educational background: MS, CGC, MSN, RN license, or relevant degrees preferred
- Organized, proactive, and able to manage multiple priorities
How to Stand Out (Preferred Qualifications):
- Experience working with a variety of payers, including appeals to state agencies and external review organizations
- Familiarity with laboratory billing systems, payer portals, and regional/national payers a plus
- Strong analytical, problem-solving, and communication skills
- Tech-savvy with Excel and data analysis tools
#PrecisionOncology #HealthcareReimbursement #CareerOpportunity #FlexibleWork #PatientCare
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