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Full-timeDescriptionAre you an experienced contracting and credentialing professional? Are you driven to succeed, and being recognized for your success? Wouldn’t you love to be a part a team where management is focused on nurturing a strong culture? If so come join us at BetterNight. We are a professional medical service and supply company, focused on sleep & sleep therapy. Our focus is on diagnosis on sleep apnea through home sleep study and treatment through the use of CPAP therapy or oral appliance therapy.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Under the supervision of the Senior Manager of Contracts and Credentialing the Health Policy Analyst will be responsible for accurate representation of all medical policies and identify any potential changes to existing medical policies. This role will be critical to ensuring all payer updates are effectively communicated throughout the organization. The Health Policy Analyst will have a strong understanding of the payor reimbursement schedules, and all fee schedules.
- Responsible for the accurate representation of medical policies/edits/updates from any payer source
- Build, utilize, and understand Medicare fee schedules, payor reimbursement schedules, fee schedules, building, manages the Internal Benefit calculator on a quarterly basis, interacting with all internal and external clients as pertains to Health Policy updates and Compliance Support Issues identified
- Present all payer updates to the organization and ensure updates are facilitated and communicated throughout the organization with the end goal of the Operations division taking the necessary actions to support updates
- Regulatory liaison between the Contracting and Credentialing department and all other Operations departments in the organization
- Identify necessary and potential changes to existing medical policies through review of current and historically available medical policies, transmittals, and bulletins. This includes but is not limited to revision and retirement of existing policies and the addition of new policies
- Extracts information from resources and translates information needed to form appropriate logic for rules.
- Also responsible for documentation and Quality Assurance review.
- Completes and reviews integrity checks with payor contracts as these edits are used, or modified to support the business
- Completes review of medical policies and publications and its integration into the required organizational files on a timely basis
- Prepares documentation and reviews as needed with the Sr. Manager and Director.
- Reviews forwarded Technical Support information/documentation for completeness and accuracy Composes responses and discusses with all appropriate internal departments as necessary.
- Maintains all medical rule editorials in the appropriate Medical Policy files in efforts to create programmatic tools with ability to research and analyze data
- Responsible for timely and accurate research of resources that update critical information on a scheduled basis. Stays abreast of all payor updates as puritans to the management of Sleep Apnea.
- Responsible for Medicaid certification/enrollment and maintaining enrollment requirements.
- Must be knowledge of Medicare certification/enrollment and maintaining enrollment requirements.
- Responsible for appropriate documentation in respective software programs, Evisort and Modio as applicable.
- Responds to quarterly updates with contracted payers per guidelines, creates and manages workflow, ensure the contracted insurance directories are current.
QUALIFICATIONS
Possesses the ability to maintain effective working relationships and has the ability to exercise independent judgement. Strong customer service skills and the ability to multitask. Must be extremely detail oriented, organized, and neat in person and habits. Must be proficient in using Microsoft suite -Excel, including creating spreadsheets, MS office, PowerPoint presentation, and general computer skills. Must have knowledge of Medical Terminology as pertains to Sleep Medicine, general knowledge of anatomy and physiology, and knowledge of Medicare reimbursement guidelines. The ideal candidate will have a growth mindset and be willing to collaborate with others to produce results.
They will embrace change and be willing to challenge status quo while providing innovative ways to solve problems. They will be accountable to themselves and to others.
EDUCATION and/or EXPERIENCE
An Associate’s or Bachelor’s degree in the Life Sciences is preferred Bachelor’s degree or three (3) years of experience in a directly related field preferred. High School Diploma or General Education Development (GED) required. Minimum of five (5) years of experience in healthcare required, preferably in DME and or professional sleep medicine specialty environment. Experience with Evisort and Modio preferred.
LANGUAGE SKILLS
Excellent oral and written communication skills. Ability to interface with patients in a polite and professional manner, as well as all levels of the organization from employees to top-level management. Ability to speak clearly and concisely, and the ability to respond to irate callers in a calm and polite manner. Ability to read, analyze, and interpret general business periodicals, professional journals, contracts, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals.
Ability to effectively present information and respond to questions from groups of managers, employees, and the general public.
MATHEMATICAL SKILLS
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percentages.
REASONING ABILITY
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions and situations furnished in written, oral, diagram, or schedule form.
CERTIFICATES, LICENSES, REGISTRATIONS
Preferred certifications include:
- Certified Provider Credentialing Specialist through NAMSS
- Registered Health Information Technology (RHIT) through American Health Information Management Association
- Proficiency in advanced Microsoft Office, certification preferred
PHYSICAL DEMANDS
The position generally involves continuous sitting, and continuous use of a computer, including keyboarding. Frequent use of a telephone and virtual meeting equipment is necessary. Occasional walking, occasional standing, light to moderate carrying, occasional bending and reaching.
WORK ENVIRONMENT
The work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Fully remote workers must adhere to all work from home policies, including the Work from Home Expectations policy. The duties and responsibilities are generally performed in an office environment. The noise level in the work environment is usually moderate. Compensation: $25.00/hour - $34.00/hour DOE
BetterNight is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with contractor's legal duty to furnish information. 4I CFR 60-I.35(C).
Salary Description$25.00-$34.00
