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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.

• 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 developments on matters affecting specialty testing. Communicate LabCorp's policy positions, strategy and tactics, and advocate oncology positions with regard to new or amended legislation, regulations, or public policy.

• Develop and maintain key contacts and relationships with policy makers for Medicare contractors, Medicaid payers and Commercial insurers. Ability to collaborate with third party groups affected by coverage and reimbursement policies, guidelines and regulations that impact specialty genetic testing services.

• 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 5%) to meet fact-to-face with payers, industry leaders, and LabCorp specialty testing and RCM business units.

• Minimum Years of Experience: 5+ years of experience in a clinical and business setting with genetic experience preferred.
• Working knowledge of the laboratory revenue cycle preferred.
• Must Have: 2+ years appeals writing or reviewing experience.
• Minimum Degree: MS, CGC, or MSN with current RN licensure, or BS, BA or other advanced degree preferred.