Sr Payer Policy Analyst - remote

At Labcorp, you are part of a journey to accelerate life-changing healthcare breakthroughs and improve the delivery of care for all. You’ll be inspired to discover more, develop new skills and pursue career-building opportunities as we help solve some of today’s biggest health challenges around the world. Together, let’s embrace possibilities and change lives!

Basic Purpose: 

The Senior Payer Policy Analyst for Specialty Testing is responsible for supporting precision medicine products with policy and alliance development activities for the company, including implementation of clinical appeal strategies to impact reimbursement and influence payer policy for next generation sequencing assays. The Analyst will act as internal conduit to gather and share information as it relates to payer policy, billing and reimbursement issues.

Duties and Responsibilities:

• Works directly with 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 specialty genetic testing 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 specialty testing 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 in crafting effective payer appeal letters for specialty testing 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 specialty testing.     
• Effectively communicate developments and updates on a regular basis through periodic reporting mechanisms and appropriate internal and external communication channels. Assists in advocating company positions both written and orally.

• Maintain a thorough knowledge of regulatory processes and policy …