Payor Analyst – Reimbursement HUB Services

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

📋 Description

• Manage the Payer Information Management System database files, which include healthcare professional and insurance databases.

• Comprehend and revise payer processing details, prior authorization and appeal requirements, contact data, forms, and best practices.

• Gather and verify new payer insights from various cross-functional teams.

• Act as a liaison among the hub, field reimbursement, market access, and analytics teams.

• Clean and refresh existing system files.

• Receive updates and notices from payers, input them into the payer database, and inform staff of any changes.

• Alert relevant departments about payer modifications and maintain records for future reference.

• Develop payer roadmaps that direct users to billing, prior authorization, and appeal documentation and procedures.

• Assist the Quality team with documentation for audits and deep-dive requests, which may include internal, external, onsite, Medicaid, and PDE audits.

• Prepare progress presentations and deliver updates to clients during monthly or quarterly business reviews.

• Educate staff on departmental policies and procedures to enhance first-submission success.

• Serve as a subject matter expert for operations and instruct clients on best practices.

• Collaborate with client stakeholders to disseminate intelligence on payer trends and changes.

• Participate in payer focus groups and other meetings to identify and communicate payer nuances and trends.

• Provide ongoing insights and key takeaways to both internal and client stakeholders.

• Work with leadership to relay updates to hub stakeholders and collaborate with Quality to implement learnings in practice.

⛳️ Requirements

• Minimum of 5 years of professional work experience is required.

• Payer experience in healthcare reimbursement, PBM, or hospital settings is strongly preferred.

• At least 3 years of experience with MS Office is necessary.

• Background in Health Care or Reimbursement with 1-3 years of auditing and quality assurance experience preferred.

• Familiarity with insurance plans, including government payers such as Medicaid, Medicare, and Tricare.

• Knowledge and skills to comprehend insurance benefits, particularly the prior authorization and appeal processes.

• Experience with medical terminology is required.

• 1-3 years of related industry experience and/or training; or an equivalent combination of education and experience.

• Demonstrated leadership skills are essential.

• Proven ability to manage multiple tasks simultaneously and prioritize effectively.

• Capability to work with a high degree of accuracy and attention to detail.

• Strong attention to detail, organizational skills, prioritization and follow-up abilities, effective communication, and ownership of one’s work.

• Proficiency in Excel, Access, Word, and PowerPoint.

• Excellent written and verbal communication skills, including the ability to interact with internal/external business partners in person or by phone.

• Ability to collaborate effectively with other internal/external functional departments.

• A High School Diploma or GED is required.

• Must be available to work Monday through Friday, from 8:00 AM to 4:30 PM ET.

🏝️ Benefits

• Remote work opportunities.

• Competitive salary packages.

• Opportunities for career advancement.

• 401K plan with company matching.*

• Tuition reimbursement programs.

• Flexible working environment.

• Discretionary Paid Time Off (PTO).

• Paid holidays.

• Employee assistance programs.

• Medical, dental, and vision insurance coverage.

• Health Savings Account (HSA) and Flexible Spending Account (FSA).

• Telemedicine services (Virtual doctor appointments).

• Wellness program initiatives.

• Adoption assistance services.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance options.

• Discount programs available.