Providence Medicare Policy Implementation Analyst in Beaverton, Oregon
Providence St. Joseph Health is calling a Medicare Policy Implementation Analyst to our location in Beaverton, OR.
We are seeking a Medicare Policy Implementation Analyst who will be primarily responsible for the development, review, and compliance of Providence Health Assurance (PHA) medical policies. This position will also be responsible for leading the development of several PHA medical policies related to Health Care Service savings initiatives. The analyst will lead PHA medical policy compliance-related initiatives and projects, including the development of a proactive monitoring program for changes in Medicare (CMS) guidance affecting PHA medical policies. This project work will be multi-faceted requiring complex regulatory analysis and interpretation, extensive consultation with PHA Regulatory & Compliance colleagues, and the integration of project outcomes into the PHA medical policy development process. This position will ultimately serve as an internal subject matter expert regarding CMS coverage guidance and regulations affecting our administration of PHA medical policies. The work of this position will impact PHA's regulatory obligations to CMS, as well as our obligations to our Medicare providers and members.
In this position you will have the following responsibilities:
Develop and maintain (at least annually) all Providence Health Assurance (PHA) medical policies.
Conducts medical coding (CPT/HCPCS/ICD-10) review to support the configuration of codes as related to the PHA medical policies (e.g., prior authorization requirements).
Establish and maintain a proactive monitoring plan for changes in CMS guidance ultimately affecting PHA medical policies.
Investigates and considers member benefits, provider network contracts, regulatory and compliance requirements and claims and medical management systems configuration to assure policies can be administered in-line with these business areas.
Analyzes and interprets utilization data to inform decisions regarding utilization management initiatives and related cost savings.
Project manager for various medical policy savings initiatives related to our Medicare business.
Supports the commercial policy analysts in the development of commercial medical policies which may also be applicable to our Medicare business.
Serves as an internal subject matter expert regarding CMS coverage guidance and regulations.
Analyzes, interprets, and clearly communicates to PHP staff any CMS guidance, rules, and regulations affecting our administration of PHA medical policies.
Consults regularly with internal and external CMS regulatory resources in order to fulfill the duties of the position.
Provides training and support regarding PHA medical policies to end-users.
Participates in medical policy and new technology committee meetings to present medical policy drafts, key findings and recommendations.
Assists in workload distribution of the team and may represent the medical policy team at various internal and external meetings, if applicable.
Actively participates in and contributes to team meetings, efficiency efforts, process improvements, group well-being and cohesion.
Required qualifications for this position include:
Bachelor's Degree in Public Policy, Health Policy and Research, Public Health, Political Science or 5 years of experience in a closely related field.
2 years relevant health plan, compliance, CMS and/or legal experience or experience in another regulated industry.
Technical or legal reading and writing experience.
Experience conducting internet research and using various online databases.
Preferred qualifications for this position include:
Policy and procedure development experience.
Medical coding (CPT/HCPCS/ICD-10) experience or familiarity with medical coding for medical technologies, procedures, and services.
Project management experience.
About Providence in Oregon.
As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities. The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple, "Providence will provide the best care and service to every person, every time."
Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Compliance
Req ID: 296694