Overview

The Coverage Analyst is responsible for analyzing clinical records and determining if the records meet the payer’s coverage criteria to prevent and overcome reimbursement barriers resulting in improper payment. The Coverage Analyst works closely with Product Specialists, Compliance Managers and associated cross-functional team members to obtain and review necessary documentation and supports ongoing training and education of customers (physicians, clinicians, and clinic staff) on coverage criteria and policy information. This position requires attention to detail, critical thinking skills, excellent oral and written communication skills and an understanding of payer medical policies.

Below is the salary range for this position, although offers may differ based on the candidate’s location, job-specific knowledge, skills, and experience.

$52,500 - $87,400

Additional benefits:

Exempt - Our total compensation package includes medical, dental and vision benefits, retirement benefits, employee stock purchase plan, paid time off, parental leave, family medical leave, volunteer time off and additional leave programs, life insurance, disability coverage, and other life and work wellness benefits and discounts. Benefits may be subject to generally applicable eligibility, waiting period, contributions, and other requirements and conditions.

Responsibilities

Accountabilities & Responsibilities

• Evaluate medical records to identify clinical components meeting medical policy criteria
• Make determinations based on evidence in record reviews in support of the Clinical Record Review program
• Collaborate with internal teams and customers (e.g., prescriber, clinician, staff) in the evaluation of medical record documentation meeting Medicare policy criteria for pneumatic compression devices
• Provide training, education, and resources to stakeholders on all aspects of Medicare policies to ensure an understanding of documentation requirements to meet Medicare policy criteria
• Perform ongoing critical review of internal Medicare documentation to reduce the risk of improper payments
• Communicate analysis of medical records to leadership via reports, dashboards and in meetings
• Collaborate with pertinent internal departments to develop successful Medicare claim and appeal submissions
• Develop and foster a strong and effective relationship with all internal and external customers
• Ensure daily workflow tasks are performed accurately and timely to ensure company goals are met
• Stay up to date on Medicare policies including National Coverage Determination(s), Local Coverage Determination(s), related Policy Articles and the Medicare Program Integrity Manual.
• Other duties as assigned

Knowledge & Skills

• Understanding of Medicare methodologies (coding, coverage, clinical criteria, payment)
• Demonstrated ability to communicate clearly and effectively with all levels of the organization
• Customer service skills
• Strong critical thinking skills Proven track record of building effective relationships with stakeholders
• Strong collaborative style, both internally and externally, to ensure objectives are met
• Results driven and proactive
• Ability to clearly document evidence with excellent attention to details
• Highly skilled in Microsoft Office Suite (Outlook, Excel, Word, PowerPoint)

Qualifications

Education & Experience

Required:

• Bachelor’s degree or equivalent work experience
• 2+ years of experience in market access, payer relations, provider relations, medical device, reimbursement, or healthcare administration
• Excellent analytical skills with ability to navigate ambiguity
• Strong training and presentation experience
• Experience working with sales functions/teams

Preferred:

• Previous experience with third-party payer regulations and processes, with emphasis on Medicare
• Reimbursement, payer relations or previous market access experience
• Previous experience working with clinic staff
• Clinical background, education or training experience

Competencies

Competencies

• Change Agent
• Influencing
• Planning
• Communication
• Documentation
• Process Management
• Priority Setting
• Peer Relationships
• Problem Solving
• Technically Savvy