The Payment Policy Analyst I functions as an internal subject matter expert and works closely with cross functional team members In Medicare/Medicaid reimbursement methodologies, laws and regulations under the mentorship and guidance of a more experienced Policy Analyst. This hire must be organized, possess good communication and writing skills, and have impeccable attention to detail in order to meet assigned deliverables prior to the end of sprint cycles. The ideal candidate will be a true team player who is flexible to lend a hand on other projects as needed. This role presents an excellent opportunity to learn the basis of healthcare payment methodologies.

Your Impact:

• Read and analyze Medicare/Medicaid data and policy, including proposed and final rules, daily transmittals, bulletins, policy manual updates, physician fee schedule (data file). Contact various government entities to clarify new and existing policy.
• Interpret and deliver business requirements covering reimbursement updates and payment policy changes and enhancement features for translation into software design specifications.
• Create detailed and accurate Excel formulas to explain and prove complex payment methodologies.
• Coordinate with developers, QA, data, client service and other team members to ensure that business requirements are implemented accurately and timely 
• Develop accurate and comprehensive test claims for Developers, UAT and QA.
• Develop and maintain proficiency in the Company’s products (software, data) and services, including commercial contracting features as related to the specific area(s) assigned.
• Become familiar in assigned Provider Payment Systems like APC, DRG, RBRVS.

What You Bring:

• Bachelor’s degree in a healthcare or comparable field.
• 1-3 years professional experience in healthcare, and working knowledge of health care reimbursement systems and methodologies
• Ability to effectively communicate and collaborate with diverse internal and external stakeholder groups and individuals.
• Ability to collect, research, and understand diverse information, and translate it into clear and concise written requirements.
• Ability to plan, prioritize, and balance the need for direction with self-motivated efforts.
• Strong interpersonal skills

Bonus Points:

• Experience in an agile systems development life cycle (SDLC) environment.
• Experience using MS Office (Word, Excel, PowerPoint, Visio, Access) software applications
• Experience using various Web-based and other research sources and tools

HealthEdge commits to building an environment and culture that supports the diverse representation of our teams. We aspire to have an inclusive workplace. We aspire to be a place where all employees have the opportunity to belong, make an impact and deliver excellent software and services to our customers.

Geographic Responsibility: While the office is located in Alexandria, VA you may live anywhere in the U.S.

Type of Employment: Full-time, permanent

Travel%: 0

FLSA Classification (USA Only): Exempt

Budget/Revenue Responsibility: 0

Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job: 

• The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
• Work across multiple time zones in a hybrid or remote work environment.
• Long periods of time sitting and/or standing in front of a computer using video technology.
• May require travel dependent on company needs.

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990.  Candidates may be required to go through a pre-employment criminal background check.

HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities.

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