Payment Policy Analyst -100% Remote

The Payment Policy Analyst is responsible for promoting compliance and regulatory requirements within Healthfirst. The role supports the Reimbursement Operating Council by developing, drafting, and finalizing reimbursement policies. The position plays a key role in the development of new policies to facilitate improved regulatory compliance with Claims and Reimbursement guidelines.

Duties & Responsibilities:

• Facilitate the Healthfirst reimbursement and billing guidelines policy process, including developing new policies, monitoring industry reimbursement policy trends, and tracking annual renewals
• Conduct industry/market research on New York Medicaid and CMS reimbursement methodologies to support creation of reimbursement and billing guidelines
• Format reimbursement policies, collaborate with stakeholders, perform editorial review, check policy references, and obtain necessary approvals
• Collaborate with the Regulatory, Compliance, Legal and key stakeholder departments to organize deliverables, prepare materials, and take minutes for committees
• Prepare reports for the Reimbursement Operating Council (ROC) and any other applicable governance committees
• Identify potential organizational risks and help facilitate process improvements
• Review the appropriate reimbursement policies, billing procedures, and make recommendations for policy creation/revision and/or committee action

• Build sustainable relationships of trust through open and interactive communication with cross-functional teams at all levels of management

• Comply with HIPAA requirements and maintain Protected Health Information (PHI) confidentiality of member, provider, medical, and departmental information
• Ensure adherence to local, state, federal, and Healthfirst specific compliance and regulatory guidelines and ensure a timely and accurate response to any requests for information or audits

Minimum Qualifications:

• Associate degree or equivalent work experience
• Experience with creation of formal policy and procedures
• Familiarity with reimbursement methodologies
• Previous compliance experience within a managed care environment
• Familiarity with reimbursement terminology
• Knowledge of CMS and/or New York State DOH reimbursement methodologies
• Experience working in a fast-paced environment that requires adapting to change while handling multiple priorities simultaneously
• Work experience requiring effective communication verbally and in writing while demonstrating good grammar, spelling, and punctuation skills
• HS Diploma or GED accredited institution

Preferred Qualifications:

• Bachelor’s degree or equivalent work experience
• Experience with project management
• Thorough understanding of reimbursement terminology
• Thorough understanding of Medicaid /Medicare reimbursement methodologies
• Experience presenting and communicating to cross-functional groups within an organization
• Problem-solving ability and critical thinking skills
• Experience with Microsoft Word, Excel, PowerPoint, Adobe Acrobat, SharePoint and corporate email systems

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [email protected] or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $67,200 - $97,155

• All Other Locations (within approved locations): $59,800 - $88,910

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.