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Senior Payer Policy Analyst
Location
North Carolina
Posted
72 days ago
Salary
$75K - $100K / year
Seniority
Senior
Job Description
Senior Payer Policy Analyst
Labcorp
• Works directly with Segment Science and Marketing management teams to develop an understanding of existing and emerging technologies to provide education, appeals influence and insight pertaining to payer policy for Government and Commercial payers. • Provide support to include attending Payer meetings with Payor Solutions Account Executives to communicate specific policy concerns and denials trends. • Regularly monitors payer policy updates and changes such as NCD, LCD and other commercial insurance coverage policies impacting reimbursement. • Functions as a liaison between Labcorp Sales, Medical Directors, and Government and Commercial Payer Medical Directors on issues pertaining to existing payer policies and proposed policy changes impacting reimbursement. • Will assist the Manager(s) with subject matter expertise for the development of comments on regulatory proposals, written testimony, policy position papers and regulations that affect the company, analyzing public policy, legislative and regulatory proposals, and reporting internally as required. • Collaborates with Sales and client accounts as a subject matter expert on payer policies and prior authorization requirements. • Communicates developments and updates on a regular basis through periodic reporting mechanisms and appropriate internal and external communications channels. • Examines health care trends, monitors implementation of Government Health Care Acts to inform business of implications and identify potential opportunities and/or risk for Medicare, Medicaid, Accountable Care Organizations, and Commercial payers. • Evaluates laboratory-related state legislation and laws to engage subject matter experts to determine potential impacts and next steps • Develops and maintains key contacts within Labcorp’s Sales leadership and Payor Solutions leadership to collaboratively address and improve reimbursement for medically necessary testing performed. • Performs other and further duties and responsibilities as shall be assigned by the manager, Director and/or Vice President of Payer Policy.
Job Requirements
- Bachelor’s degree and 5 years work experience required or Associate degree with 7 years relevant work experience or High School diploma with 9 years relevant work experience required
- Certified Genetic Counselor
- Advanced degree; MBA, JD, M.A. / M.S., CGC, RN
- Three or more years work experience with state and federal agencies and/or commercial insurance payers
- Three or more years work experience in healthcare revenue cycle (prior authorization, coding, claims, denials, appeals, billing compliance, etc.)
Benefits
- Medical
- Dental
- Vision
- Life
- STD/LTD
- 401(k)
- Paid Time Off (PTO) or Flexible Time Off (FTO)
- Tuition Reimbursement
- Employee Stock Purchase Plan
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Health IT Informatics Analyst
GovCIOGovCIO is a service-disabled-veteran-owned small business (SDVOSB) that offers technology services to improve business performance for government organizations.
Overview GovCIO is seeking a Health IT Informatics Analyst to support complex healthcare technology initiatives through clinical workflow analysis, health IT requirements development, and informatics leadership. This role serves as a key liaison between clinical stakeholders, technical teams, and operational leaders to ensure healthcare technology solutions are aligned with real-world care delivery and system usability. The Lead Health IT Informatics Analyst will play a critical role in translating clinical and operational needs into actionable requirements, supporting system configuration and validation activities, and ensuring the quality and consistency of informatics deliverables across initiatives. This position will be located fully remote. Responsibilities - Writes complex SQL queries and Azure Databricks Notebooks to support Power BI Semantic Model development - Develops Power BI Semantic Models and Report visualizations - Lead requirements elicitation, workflow analysis, and functional documentation for healthcare technology initiatives - Partner with clinicians, product teams, developers, and operational stakeholders to translate needs into clear informatics and system requirements - Support and advise on clinical system configuration, workflow optimization, and usability alignment - Develop and maintain key project artifacts, including requirements documents, process flows, use cases, user stories, and validation materials - Lead and support user acceptance testing (UAT), issue identification, and workflow validation activities - Provide subject matter expertise in clinical workflows, health IT systems, and informatics best practices - Ensure the quality, consistency, and traceability of informatics deliverables across initiatives - Identify workflow, documentation, or system gaps and partner with teams to develop practical solutions - Support implementation and adoption efforts through stakeholder engagement, testing, and feedback incorporation - Mentor or guide other informatics analysts and contribute to overall work quality across the team Qualifications Required Skills and Experience: - Bachelor’s degree required (or commensurate experience) - Minimum 15 years of professional experience, including at least 6 years of specialized health informatics experience - Additional specialized health informatics experience may be considered in lieu of some educational requirements, where applicable - Demonstrated experience in requirements elicitation, workflow analysis, and health IT documentation development - Experience leading or supporting user acceptance testing (UAT) and system validation efforts - Extensive experience with clinical workflows and health IT systems - Strong understanding of system configuration, healthcare operations, and end-user needs - Ability to work effectively across clinical, technical, and operational teams Preferred Skills and Experience: - Experience with Oracle Health and/or CPRS/VistA configuration strongly preferred - Experience supporting federal healthcare environments or large integrated healthcare systems preferred - Clinical background or experience working closely with clinicians and care teams preferred - Familiarity with Agile, product, or iterative delivery environments preferred Clearance Required: Ability to obtain and maintain a Suitability/Public Trust clearance. Company Overview GovCIO is a team of transformers--people who are passionate about transforming government IT. Every day, we make a positive impact by delivering innovative IT services and solutions that improve how government agencies operate and serve our citizens.But we can't do it alone. We need great people to help us do great things - for our customers, our culture, and our ability to attract other great people. We are changing the face of government IT and building a workforce that fuels this mission. Are you ready to be a transformer? What You Can Expect Interview & Hiring Process If you are selected to move forward through the process, here’s what you can expect: - During the Interview Process - Virtual video interview conducted via video with the hiring manager and/or team - Camera must be on - A valid photo ID must be presented during each interview - During the Hiring Process - Enhanced Biometrics ID verification screening - Background check, to include: - Criminal history (past 7 years) - Verification of your highest level of education - Verification of your employment history (past 7 years), based on information provided in your application Employee Perks At GovCIO, we consistently hear that meaningful work and a collaborative team environment are two of the top reasons our employees enjoy working here. In addition, our employees have access to a range of perks and benefits to support their personal and professional well-being, beyond the standard company offered health benefits, including: - Employee Assistance Program (EAP) - Corporate Discounts - Learning & Development platform, to include certification preparation content - Training, Education and Certification Assistance* - Referral Bonus Program - Internal Mobility Program - Pet Insurance - Flexible Work Environment *Available to full-time employees Our employees’ unique talents and contributions are the driving force behind our success in supporting our customers, which ultimately fuels the success of our company. Join us and be a part of a culture that invests in its people and prioritizes continuous enhancement of the employee experience. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender, gender identity or expression, sexual orientation, national origin, disability, or status as a protected veteran. EOE, including disability/vets. Posted Pay Range The posted pay range, if referenced, reflects the range expected for this position at the commencement of employment, however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, education, experience, and internal equity. The total compensation package for this position may also include other compensation elements, to be discussed during the hiring process. If hired, employee will be in an “at-will position” and the GovCIO reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, GovCIO or individual department/team performance, and market factors. Posted Salary Range USD $175,000.00 - USD $190,000.00 /Yr.
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Description: Schedule: Monday-Friday 8:00am-5:00pm EST Aetna’s Healthy Aging Support Program is a short term, self-management education program. The Health Coach provides information, referral, assistance with accessing resources, health coaching, and supportive care to Medicare members. The Health Coach will instruct group coaching classes on specific content addressing common health concerns for members with chronic conditions, providing education and resources, and effectively utilizing community, health care, and plan benefit resources. Fundamental Components: - Educate members on an array of topics such as Managing Medicines, Nutrition, Safety, Benefits/ Resources, Mindfulness and Working with Care Team and empower participation of the group coaching participants - Assist the member in actively participating with their health care providers and Aetna Care Management teams regarding decisions that impact their health and well-being - Document all member interaction into the appropriate member record(s) - Demonstrate empathy for situations faced by our members and their caregivers - Troubleshoot unavailability of resources, securing support as needed to close member gaps - Follow program workflows consistently, following up with members to review personal action plan and determine if any additional referrals (e.g., Care Management, Behavioral Health, etc) are needed Background Experience: - At least 2 years working as a Health Coach - Candidates with experience in care management, healthcare, social work, aging network, or similar backgrounds Preferred: - Bilingual - Community Health or Public Health experience - Managed Care: Medicare experience Education: - Associate's Degree Required, Bachelor's preferred - Health Coach Certification preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $21.10 - $36.78 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: - Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. - No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. - Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 04/10/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.




