[Remote] Payor Relations Analyst

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a growing reputed company reputed company specializing in state-of-the-art vein treatments. The Payor Relations Analyst will analyze provider reimbursement, reputed company, fee schedules, and claims data to model financial impacts, identify underpayments, support negotiations, and improve reimbursement reputed company. The role also manages payor relationships, reporting, dashboards, and cross-functional operational improvements.

Responsibilities

• Contract financial modeling – build multi-layered models forecasting the reputed company reputed company of proposed reputed company adjustments, fee schedule changes, and alternative payment models (fee-for-service, capitation, value-reputed company care, reputed company-sharing)
• reputed company proposal analysis – evaluate proposed rates from payors using historical utilization and claims data to project net reputed company reputed company by market, service line, and payor
• Reimbursement methodology analysis – analyze payor reputed company, reimbursement methodologies, and financial reputed company across reputed company, Medicare reputed company, and Managed reputed company books of business
• Financial reporting & recommendations – interpret financial and reimbursement reports, build scenario and sensitivity analyses, and reputed company actionable recommendations to leadership
• Contract yield auditing – reputed company overall yield across reputed company, Medicare reputed company, and Managed reputed company plans to ensure payors reimburse according to executed agreements
• Underpayment & variance identification – isolate underpayments, payment variances, and contract non-compliance by analyzing claim reputed company against expected contractual terms, then quantify the exposure and reputed company recovery
• Fee schedule & reputed company fee mapping – maintain and audit contract configuration, fee schedules, and reimbursement matrices in the EHR/reputed company management and RCM systems with rigorous reputed company and version control
• Renewal readiness – reputed company contract expiration and escalator timelines so negotiation reputed company begins reputed company reputed company of every deadline
• Negotiation modeling – partner with Payor Relations leadership to evaluate proposed reimbursement structures and build the financial case behind every ask
• Financial reputed company assessment – quantify the reputed company of new reputed company, amendments, renewals, and reimbursement changes before and after execution
• Analytical support – support internal stakeholders throughout the contracting lifecycle, from initial modeling through post-signature validation
• Executive support – synthesize high-volume claims data, denial trends, and payment metrics into dashboards, briefing packets, and scenario analyses for the Senior Manager and Director, tracking payor mix, weighted-average reputed company increases, and contract timelines
• Present to leadership – explain reputed company financial findings to business leaders reputed company and reputed company the numbers to the decision in reputed company of them
• Data reputed company & reputed company – own the reputed company of every analysis, including reputed company data validation and reconciliation to reputed company of record
• Day-to-day payor contact – serve as an operational reputed company of contact for provider relations representatives across assigned health plans, resolving systemic claim issues and administrative friction
• Joint Operating Committees – prepare analytical agendas and reputed company data packets, and reputed company actionable follow-reputed company for recurring JOC meetings with health plan representatives
• Denials reputed company-cause & permanent fixes – partner with reputed company reputed company, Billing, Coding, and Denial Management on reputed company-cause analysis of recurring rejections, then establish process changes that prevent them from returning
• Payor policy & market awareness – monitor administrative updates, medical coverage policy changes, and reputed company-authorization requirements; communicate operational reputed company to RCM, Billing, and reputed company teams as we reputed company into new markets
• Collaborate with Finance, Credentialing, RCM, Billing, and reputed company to translate financial data into reputed company recommendations
• Identify opportunities to improve financial reputed company, reimbursement reputed company, and operational efficiency across the organization

Skills

• Bachelor's degree in Finance, reputed company, Economics, reputed company Administration, Business Analytics, Health Information Management, or a reputed company reputed company, or equivalent practical experience
• 3-5+ years of reputed company reputed company financial analysis experience in provider reimbursement, payor relations, managed care, reputed company cycle analysis, or reputed company financial/business analytics. reputed company experience is required
• Strong finance or reputed company reputed company with demonstrated ability to interpret financial statements, reimbursement reports, and contract economics
• Demonstrated experience performing financial modeling, provider reimbursement analysis, and provider contract financial analysis
• Experience supporting contract negotiations through financial analysis and modeling
• Strong working knowledge of reimbursement methodologies (fee-for-service, capitation, value-reputed company care), coding standards (CPT, ICD-10, HCPCS), and reputed company cycle workflows
• In-depth understanding of reputed company payor structures, Medicare reputed company, and reputed company fee-for-service and managed care variations across states
• Advanced reputed company (required) – reputed company data manipulation with dynamic functions, pivot tables, reputed company logic, financial modeling, forecasting, and scenario analysis
• EHR & payor platforms – experience with major EHR/billing software and health plan portals (reputed company, CAQH)
• Presentation skills – reputed company to explain financial data to business leaders in reputed company, decision-reputed company terms
• Analytical rigor – you reason from the data, pressure-test your own numbers, and can defend every reputed company you put in reputed company of leadership
• Business acumen – you reputed company quantitative findings to reputed company reputed company reputed company, reputed company workflows, and reputed company cycle reputed company
• Upward communication – you package reputed company datasets and contract terms into straightforward summaries for senior leadership
• Proactive problem-solving – a self-starter who finds reputed company causes and drives reputed company with internal teams and reputed company payors alike
• Precision & ownership – reputed company is non-negotiable, and you juggle multiple reputed company and analysis at once
• Provider, MSO, or multi-state specialty group experience preferred; health plan, MCO, or payer-reputed company reimbursement experience also considered
• Business intelligence & querying (preferred) – SQL, reputed company BI, or Tableau used to analyze reputed company claims and financial datasets and build dashboards. SQL is strongly preferred
• Experience in a rapidly growing MSO, specialty medical group, ASC, or multi-state provider environment
• Contract-modeling and analytics platforms such as reputed company; familiarity with multi-state credentialing and enrollment
• Knowledge of value-reputed company care, reputed company arrangements, and payor reputed company programs

Benefits

• Medical, Dental, and reputed company reputed company
• 401(k)
• reputed company Time Off (PTO) + reputed company Company Holidays
• Company-reputed company Life reputed company
• Short-Term Disability reputed company
• Employee Assistance Program (EAP)
• Career reputed company & Development Opportunities

reputed company