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Basic Purpose:
The Sr. Payer Policy Analyst is responsible for supporting precision medicine products for the Oncology and Genetics Enterprises with policy and alliance development activities for the company, including assembling and submission of MolDX technical assessments for genetic and molecular laboratory tests that impact reimbursement and influence payer policy for Integrated Oncology and Integrated Genetics assays. The Sr Analyst will act as internal conduit to gather and share information as it relates to payer policy, prior authorizations, billing and reimbursement issues.
Duties and Responsibilities:
- Works directly with Specialty Testing Marketing Management teams to develop an understanding of existing and emerging technologies to provide education, appeals influence and insight 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 point of contact within 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 related to technical assessments and/or appeals strategies.
- Facilitate resolution of specialty testing coverage and reimbursement issues between Payers, Government agencies and Labcorp.
- Extrapolate and summarize essential medical information for review, identifying denial trends by case type and payer-specific issues.
- Work with Policy Reporter data to understand changes in payer policy impacting reimbursement.
- Collaborate with other departments/business associates to analyze, understand and define business rules for oncology and genetic policy changes.
- Collaborate with Specialty Analytic/Support and Medical Policy teams to deploy best practices to support reimbursement capture.
- Apply critical reasoning to assess the need for formal technical assessments and collaborate with stakeholders to draft templates for new test submissions.
- Exceptional writing skills in crafting effective summaries for specialty testing to include prior authorization efforts, supportive clinical evidence, complying with all clinical and billing policies, guidelines and regulations.
- Conduct clinical evidence searches, utilize internal and external subject matter experts and/or other avenues of research to identify supportive evidence for coverage of oncology and genetics services.
- Effectively communicate developments and updates on a regular basis through periodic reporting mechanisms and appropriate internal and external communication channels. Assists in advocating company positions both written and orally.
- Maintain a thorough knowledge of regulatory processes and policy developments on matters affecting Labcorp Specialty testing. Communicate Labcorp’s policy positions, strategy and tactics, and advocate positions with regards to new or amended legislation, regulations, or public policy.
- Develop and maintain key contacts and relationships with policy makers for Medicare Contractors, Medicaid Payers and Commercial insurers. Ability to collaborate with third party groups affected by coverage and reimbursement policies, guidelines and regulations that impact oncology and genetics services.
- Support efforts at the state and federal levels as appropriate by developing responses, talking points, strategy on key issues while helping to assure policy consistency across the organization.
- Perform other and further duties and responsibilities as assigned.
- Position may require travel (up to 20%) to meet face-to-face with payers, industry leaders, and Labcorp Oncology and RCM business units.
Minimum Qualifications:
- Education: Bachelor’s degree required
- Minimum 5 years of experience in a clinical, laboratory, medical insurance, or laboratory billing setting required
- 2 years of experience creating or contributing to successful MolDX technical assessment submissions strongly preferred
- Strong understanding of genetic and molecular testing strongly preferred
- Working knowledge of laboratory revenue cycle management strongly preferred
Application Window closes: 10-24-24
Pay Range: $85K-100K (State minimum wages apply if higher)
Shift: Monday-Friday 8am-5pm (EST)
Benefits: Employees regularly scheduled to work 20 or more hours per week are eligible for comprehensive benefits including: Medical, Dental, Vision, Life, STD/LTD, 401(k), Paid Time Off (PTO) or Flexible Time Off (FTO), Tuition Reimbursement and Employee Stock Purchase Plan. Casual, PRN & Part Time employees regularly scheduled to work less than 20 hours are eligible to participate in the 401(k) Plan only.
Labcorp is proud to be an Equal Opportunity Employer:
As an EOE/AA employer, Labcorp strives for diversity and inclusion in the workforce and does not tolerate harassment or discrimination of any kind. We make employment decisions based on the needs of our business and the qualifications of the individual and do not discriminate based upon race, religion, color, national origin, gender (including pregnancy or other medical conditions/needs), family or parental status, marital, civil union or domestic partnership status, sexual orientation, gender identity, gender expression, personal appearance, age, veteran status, disability, genetic information, or any other legally protected characteristic.
We encourage all to apply
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