Description and Requirements 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 renewalsConduct industry/market research on New York Medicaid and CMS reimbursement methodologies to support creation of reimbursement and billing guidelinesFormat reimbursement policies, collaborate with stakeholders, perform editorial review, check policy references, and obtain necessary approvalsCollaborate with the Regulatory, Compliance, Legal and key stakeholder departments to organize deliverables, prepare materials, and take minutes for committeesPrepare reports for the Reimbursement Operating Council (ROC) and any other applicable governance committeesIdentify potential organizational risks and help facilitate process improvementsReview the appropriate reimbursement policies, billing procedures, and make recommendations for policy creation/revision and/or committee actionBuild sustainable relationships of trust through open and interactive communication with cross-functional teams at all levels of managementComply with HIPAA requirements and maintain Protected Health Information (PHI) confidentiality of member, provider, medical, and departmental informationEnsure 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 experienceExperience with creation of formal policy and proceduresFamiliarity with reimbursement methodologiesPrevious compliance experience within a managed care environmentFamiliarity with reimbursement terminologyKnowledge of CMS and/or New York State DOH reimbursement methodologiesExperience working in a fast-paced environment that requires adapting to change while handling multiple priorities simultaneouslyWork experience requiring effective communication verbally and in writing while demonstrating good grammar, spelling, and punctuation skillsHS Diploma or GED accredited institution

Preferred Qualifications:

Bachelor’s degree or equivalent work experienceThorough understanding of reimbursement terminologyThorough understanding of Medicaid /Medicare reimbursement methodologiesExperience presenting and communicating to cross-functional groups within an organizationProblem-solving ability and critical thinking skillsExperience with Microsoft Word, Excel, PowerPoint, Adobe Acrobat, SharePoint and corporate email systems

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.