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Career Story: Medicare Senior Policy Analyst

Medicare Senior Policy Analyst

Job Title: Senior Policy Analyst

Type of Company: I work for the Federal agency that administers the Medicare program.

Education: BA, Political Economy, Muhlenberg College •• (Allentown, PA) •• JD, Syracuse University College of Law •• MA, Political Science, Northeastern University

Previous Experience: I worked as an intern in the office of a state legislator in Massachusetts and at the Massachusetts Housing Finance Authority. I was selected for a Federal fellowship program after finishing grad school and that led to my current job.

Job Tasks: I am the senior analyst responsible for appeals policy in the Medicare program. Medicare is the national health insurance program offered to persons over 65 and certain disabled individuals. When someone with Medicare receives services, Medicare determines whether those services are covered under the program. If the services are not covered, or Medicare does not make payment for the services, the physician, hospital or other facility may ask that Medicare reconsider its decision. This is known as an appeal. I am responsible for writing the policies that govern this process. I write regulations and operational policies to implement laws passed by Congress regarding appeals in Medicare. I provide advice and guidance to staff throughout our agency regarding statutory and regulatory requirements related to Medicare appeals. I also provide clarification regarding our policies to attorneys and providers who are involved in the appeals process. I audit the work of the contractors who process Medicare appeals to make sure they comply with our requirements.

Best and Worst Parts of the Job: The best part of the job is being able to help people navigate a complicated process. The worst part is being unable to simplify the process. Medicare is a complex program and we have to balance our responsibility to ensure persons in the program have access to needed care with the limits of the program created by the Congress. Oftentimes, people do not understand that there are limits to what the Medicare program covers. When that happens, and services are denied, they need to access the appeals process. We try to make our process relatively simple to access, but it doesn't always seem that way to our beneficiaries. Being able to help someone navigate that process is rewarding.

Job Tips: Pursuing a career in the government requires dedication and sacrifice. Obtaining a graduate degree in political science or public administration is helpful. For the writing element, a degree related to writing will prove useful. Strong writing skills are essential.

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