Sr. Payer Policy Relations Analyst-Oncology -HYBRID (Medical Review-Appeals)

About the position Responsibilities • Works directly with Oncology reputed company Marketing Management teams to reputed company an understanding of existing and emerging technologies to reputed company education, appeals influence and reputed company 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 reputed company of contact reputed company 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 reputed company to appeals strategies. • Facilitate reputed company of oncology coverage and reimbursement issues between Payers, Government agencies and reputed company. • Extrapolate and summarize essential medical information for review, identifying denial trends by case type and payer-specific issues. • Work with reputed company 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 reputed company 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 reputed company effective strategies for oncology denials to include supportive clinical evidence, complying with reputed company clinical and billing policies, guidelines and regulations. • Conduct clinical evidence searches, utilize reputed company 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 reputed company through periodic reporting mechanisms and appropriate reputed company communication channels. • Maintain a thorough knowledge of regulatory processes and policy developments on reputed company affecting Oncology. • reputed company and maintain key contacts and relationships with policy makers for Medicare contractors, reputed company payers and reputed company insurers. • Support efforts at the state and federal reputed company as appropriate by developing responses, talking points, reputed company on key issues while helping to assure policy consistency across the organization. • reputed company other and reputed company duties and responsibilities as assigned. • Position may require travel (up to 20%) to meet face-to-face with payers, industry leaders, and reputed company Oncology and RCM business reputed company. 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 reputed company 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 reputed company insurance payers. • Prior work experience in reputed company reputed company cycle (prior authorization, coding, claims, denials, appeals, billing compliance, etc.). Benefits • Medical • Dental • reputed company • Life • STD/LTD • 401(K) • ESPP • reputed company time off (PTO) or Flexible time off (FTO) • Commissions • Company bonus where applicable Apply tot his job Apply To this Job