Policy Analyst - Managed Care

Description

Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:

Assists in the interpretation, communication, tracking and implementation of CMS (Medicare and Medicaid), Tricare and private payer policies that directly impact provider billing. Plays a critical role in researching, analyzing and conveying federal, state, and private policies that impacts Medicare, Medicaid, and commercial coverage, compliance and billing, along with becoming an expert on key issues related to changes in health care policy, including but not limited to health care reform.

Responsibilities:

• 1. Responsible and accountable for reviewing all relevant payer policy alerts (e.g. bulletins) and/or Notices of Proposed Rule Making and Final Rules.
• 2. Analyze payer policy changes to identify potential operational, billing, coding, or reimbursement impacts.
• 3. Support assessment of financial risk or opportunity associated with policy changes, including identification of policies that may result in underpayments or denials.
• 4. Escalate complex or high‑risk policy issues to senior analysts or leadership for deeper financial analysis.
• 5. Prepare clear, concise summaries of payer policies and their implications for non‑technical audiences.
• 6. Assist with development of standardized workflows and documentation related to payer policy analytics.
• 7. Support the driving of all necessary changes as a result of payer updates to reimbursement policies. Works collaboratively across the HCS to ensure that information and tasks are disseminated appropriately and timely.
• 8. Support the Policy Analytics team via recurring interdepartmental meetings to review policy updates and confirm ownership of follow‑up actions with relevant stakeholders.
• 9. Responsible for program and project assignments working independently or collaboratively as appropriate to accomplish the assigned work. Identify issues and assist in developing strategies to address them prior to issues becoming critical. Keep Policy Analytics team informed of project(s) status and any potential concerns.

• Bachelor’s degree in Business Administration, Health Administration, Communications or related field.

• If appropriate for the position, a willingness to secure coding certification may be required.

• Three (3) years of experience in policy interpretation and accountability in a healthcare setting.

• Strong analytical, communications, and change management skills with solid knowledge of project management. Must be able to work independently. Research, retrieve, analyze and organize data.

Legal

Employer:

NCHEALTH

Entity:
Shared Services

Organization Unit:
Managed Care

Work Type:
Full Time

Standard Hours Per Week: 40.00

Salary Range: $26.85 - $38.61 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type:
Remote

Work Schedule:

Day Job

Location of Job: US:

NC:

Morrisville

Exempt From Overtime:
Exempt:
Yes

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully‑owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation. UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities.

Please email applicant.accommodations.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.