Payer Compliance amp Policy Analyst

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Payer Compliance & Policy Analyst
The candidate will facilitates identification of payer policy changes that will impact the Affiliates and coordinate a complete analysis of the policy, including but not limited to the following areas; legal, contractual, financial and administrative. In addition, PCPA will identify those policies for implementation by UVMHN Affiliates. For both, the PCPA assists UVMHN Contracting & Payer Relations department supporting Affiliate(s) end-users to ensure payer compliance and proper payer policy implementation; drafts first level dispute to payer policy changes to mitigate loss or impact; drafts and facilitates delivery of annual Agreement notices to payers; drafts and facilitates communication of approved policy changes to Payer Matrix, system configuration, UVMHN Affiliates, and provides initial/concurrent/ongoing educational opportunities for end users. Minimum of two to three years of experience in 1) billing in a complex health care setting with multiple national payer agreements; or 2) compliance or utilization review for a highly regulated industry; or 3) complex medical claim coding in multiple specialties, or 4) statistical analysis experience. The individual must possess significant familiarity with complex healthcare operations, payer performance, payer policy review, payer prior authorization requirements, and Epic functionality.

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