Payor Analyst – Reimbursement HUB Services

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

📋 Description

• Oversee the management of the Payer Information Management System database files.

• Maintain files for Referring Healthcare Professionals and the Insurance Database, which includes payer processing details, prior authorization and appeal requirements, contact information, forms, and best practices for payers.

• Gather and verify new insights from team members across different functions.

• Act as a cross-functional liaison to comprehend and communicate changes in payer policies, requirements, and processes.

• Clean and refresh existing system files.

• Receive payer notifications and updates, appropriately load them into the payer database, and keep staff updated.

• Inform the relevant departments of any payer changes and maintain a reference file of payer notifications.

• Collaborate with operations teams to develop payer roadmaps that guide users through billing, prior authorization, appeal documentation, and procedures.

• Support the Quality team with documentation for audits and in-depth requests.

• Create progress presentations and present them to clients during monthly or quarterly business reviews.

• Educate staff on departmental policies and procedures, emphasizing how to maximize first-submission success.

• Act as a subject-matter expert for operations and inform clients about best practices.

• Partner with client stakeholders to discuss payer trends and changes.

• Engage in payer focus groups and relevant meetings.

• Provide continuous insights and key learnings to both internal and client stakeholders.

• Collaborate with leadership to communicate updates to hub stakeholders.

• Work alongside the Quality team to ensure that learnings are effectively applied in practice.

⛳️ Requirements

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

• Experience with payers, particularly 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 is preferred.

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

• Knowledge and skill in understanding insurance benefits, especially regarding prior authorization and appeal processes.

• Experience with medical terminology is required.

• 1-3 years of related industry experience and/or training, or a combination of education and experience equivalent to this.

• Proven leadership capabilities.

• Ability to manage multiple tasks simultaneously and prioritize them accordingly.

• Established track record of working with high accuracy and attention to detail.

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

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

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

• Capability to work collaboratively with other internal and external functional departments.

• High School Diploma or GED is required.

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

🏝️ Benefits

• Opportunities for remote work.

• Competitive salary packages.

• Opportunities for career advancement and promotions.

• 401K with company matching contributions.

• Tuition reimbursement programs.

• Flexible working environment.

• Discretionary Paid Time Off (PTO).

• Paid holidays.

• Employee assistance programs.

• Comprehensive medical, dental, and vision coverage.

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

• Access to telemedicine services (virtual doctor appointments).

• Wellness programs.

• Adoption assistance.

• Short-term and long-term disability coverage.

• Life insurance options.

• Discount programs available.