Sr. Payer Policy Relations Analyst-Oncology -HYBRID (Medical Review-Appeals)

About the position Responsibilities • Works directly with Oncology Segment Marketing Management teams to develop an understanding of existing and emerging technologies to provide education, appeals influence and insight pertaining to payer policy. • Manage informational needs of multiple cross functional stakeholders regarding payer coverage and reimbursement policy issues and/or changes. • Serve as a point of contact within RCM Payer Policy & Relations Team for payer information, payer communication and issue identification. • Responsible for making recommendations to management and may initiate implementation of new procedures and processes related to appeals strategies. • Facilitate resolution of oncology coverage and reimbursement issues between Payers, Government agencies and LabCorp. • Extrapolate and summarize essential medical information for review, identifying denial trends by case type and payer-specific issues. • Work with Policy Reporter data to understand changes in payer policy impacting reimbursement. • Collaborate with other departments/business associates to analyze, understand, and define business rules for oncology policy changes. • Collaborate with Prior Authorization teams to deploy best practices to support reimbursement capture. • Apply critical reasoning to assess the need for formal appeal of clinical denials and collaborate with stakeholders to draft templates for customized appeals by tumor types. • Exceptional writing skills to develop effective strategies for oncology denials to include supportive clinical evidence, complying with all clinical and billing policies, guidelines and regulations. • Conduct clinical evidence searches, utilize internal and external subject matter experts and/or other avenues of research to identify supportive evidence for coverage of oncology services. • Effectively communicate developments and updates on a regular basis through periodic reporting mechanisms and appropriate internal and external communication channels. • Maintain a thorough knowledge of regulatory processes and policy developments on matters affecting Oncology. • Develop and maintain key contacts and relationships with policy makers for Medicare contractors, Medicaid payers and Commercial insurers. • Support efforts at the state and federal levels as appropriate by developing responses, talking points, strategy on key issues while helping to assure policy consistency across the organization. • Perform other and further duties and responsibilities as assigned. • Position may require travel (up to 20%) to meet face-to-face with payers, industry leaders, and LabCorp Oncology and RCM business units. Requirements • Minimum Years of Experience: 5+ years of relevant work experience in a clinical and business setting • Strong preference given to Advanced degree; MBA, JD, M.A. / M.S., CGC, RN • Previous Oncology work experience • Prior Genetic Counseling work experience • Prior work experience in a clinical or business setting. • Prior work experience with insurance guidelines and payer policy. • Familiarity with clinical practice guidelines of national organizations such as NCCN, ACMG, ACC and AHA. • Prior work in case reviews for medical necessity. • Prior work experience with state and federal agencies and commercial insurance payers. • Prior work experience in healthcare revenue cycle (prior authorization, coding, claims, denials, appeals, billing compliance, etc.). Benefits • Medical • Dental • Vision • Life • STD/LTD • 401(K) • ESPP • Paid time off (PTO) or Flexible time off (FTO) • Commissions • Company bonus where applicable Apply tot his job Apply To this Job