Payer Operations Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Identify, triage, route, and resolve data quality challenges across over 1,200 payer data feeds.

• Collaborate with payers and internal teams to troubleshoot SFTP connection issues, delivery delays, and file transmission failures.

• Manage clinical quality submission audits by overseeing audit documentation, organizing patient data files, and sourcing clinical evidence.

• Ensure accurate maintenance of contract metadata, including contract names, TINs, and administrative details.

• Investigate and rectify manual care gap upload failures.

• Work alongside Payer Solutions, Product, Engineering, Field Operations, and payer partners to resolve data-related challenges.

• Convey complex data insights and technical concepts to both technical and non-technical stakeholders.

• Lead cross-functional data initiatives from the discovery phase through to implementation.

• Act as a subject matter expert on payer data, analyzing feed and metric anomalies.

• Maintain Standard Operating Procedures (SOPs) for data issue triage, clinical ingestion troubleshooting, and Primary Source Verification audits.

• Address root causes, enhance payer feed quality, and optimize internal ingestion workflows.

• Perform other assigned duties as needed.

⛳️ Requirements

• Bachelor’s Degree.

• 4+ years of experience in data operations, analytics, product management, or similar technical roles dealing with complex data in healthcare, product development, SaaS, or comparable environments.

• Intermediate proficiency in SQL programming.

• Technical fluency in data warehouses, BI and visualization software, file-transfer systems, and workflow management tools, including Snowflake, Databricks, Tableau, SFTP, and Jira.

• Ability to navigate intricate data environments and trace data flows across both internal and external systems to identify root causes.

• Demonstrated ability to collaborate within cross-functional teams and communicate technical insights and business impacts to a diverse range of stakeholders.

• Proactive and inquisitive mindset with the capability to understand system architecture, navigate complex data ecosystems, and enhance processes.

• Expertise in the healthcare domain with knowledge of value-based care, Alternative Payment Models (APMs), Medicare, and non-MSSP quality measures (preferred).

• Ability to sit for prolonged periods at a desk and work on a computer.

🏝️ Benefits

• Flexible work schedules and remote work options are available for many positions.

• Health, dental, and vision insurance is covered up to 80% for employees, dependents, and domestic partners.

• Comprehensive time-off plan offering 21 days of PTO in your first year.

• Two paid volunteer days and 11 paid holidays.

• 12 weeks of paid parental leave for all new parents.

• Six weeks of paid sabbatical after six years of service.

• Educational Assistant Program and Clinical Employee Reimbursement Program.

• 401(k) plan with a match of up to 4%.

• Stock options.