Senior Finance Manager – Payer Strategy & Analytics

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

📋 Description

• Act as the primary analytical partner for Payor Contracting, Revenue Cycle/AR Follow-Up, Legal, Finance, Accounting, and Operations regarding reimbursement strategies.

• Develop financial models and provide recommendations for negotiations, renewals, and terminations of payor contracts.

• Assess in-network versus out-of-network scenarios based on payor and market analysis.

• Ensure that revenue recognition, budgets, and forecasts accurately reflect anticipated IDR, arbitration, and litigation outcomes.

• Take ownership of analytics related to the federal No Surprises Act IDR and state arbitration initiatives.

• Monitor dispute metrics including volume, eligibility, filing deadlines, cycle time, win/loss rates, award amounts, and return on dispute costs.

• Analyze federal IDR Public Use Files from CMS as well as internal IDR determination data.

• Review IDRE selection and determination trends and recommend strategies for selection and objections.

• Formulate offer and rate strategies for IDR and arbitration submissions.

• Evaluate and report on payor contract performance, yield, rate benchmarks, escalators, and instances of underpayment.

• Collaborate with AR Follow-Up and Revenue Cycle leaders to prioritize workload and optimize the timing of disputes.

• Conduct data analysis, underpayment and damages modeling, and prepare exhibits for payor litigation and enforcement of awards.

• Keep track of regulatory, legal, and industry trends while communicating their business implications.

• Perform diligence revenue assessments for potential payor contracts and acquisitions.

• Create and uphold dashboards, performance metrics, and ad-hoc analyses.

• Establish analytics and data collection standards to maintain the integrity of dispute, claims, and contract data.

• Execute other related responsibilities as required.

⛳️ Requirements

• Bachelor’s degree in Business, Finance/Accounting, Economics, Health Policy, Informatics, or a related discipline, or equivalent experience (MBA or master's preferred).

• Minimum of 5 years of experience in reporting, analytics, and business operations, ideally within the healthcare/provider sector.

• At least 2 years of hands-on experience in payor contracting analytics, out-of-network reimbursement, or No Surprises Act IDR/state arbitration analytics.

• 2-3 years of leadership experience is required.

• Familiarity with the No Surprises Act, the federal IDR process, the qualifying payment amount (QPA), and state surprise billing and arbitration frameworks.

• Capability to analyze large public and proprietary datasets and translate insights into clear strategic recommendations.

• Deep understanding of payor contracting, fee schedules, claims adjudication, remittance and EOB data, as well as emergency medicine professional billing and coding.

• Strong financial acumen and advanced analytical abilities, including benchmarking, forecasting, and scenario/sensitivity modeling.

• Proficiency in Excel, PowerPivot, and a business intelligence tool such as Power BI or Tableau.

• Experience with SQL, Python, or R is preferred.

• Excellent business acumen and interpersonal abilities.

• Outstanding oral and written communication and presentation skills.

• Good judgment in handling confidential, privileged, and protected health information.

• Ability to oversee complex projects and meet departmental objectives.

• Exceptional time management, organizational, and problem-solving capabilities.

• Preferred: experience with emergency medicine or other hospital-based physician groups, as well as experience assisting litigation or arbitration processes alongside Legal and outside counsel.

• Capacity to sit for extended periods and occasionally walk, stand, bend, stoop, and lift up to 15 pounds.

• Close visual acuity is necessary.

• U.S. work location indicated by “Virtual USA.”

🏝️ Benefits

• Options for medical, dental, and vision insurance.

• Health savings accounts (HSA) and flexible spending accounts (FSA).

• 401(k) with employee and employer contributions.

• Paid time off, including vacation, sick leave, and company holidays.

• Paid parental leave and family support benefits.

• Short-term and long-term disability insurance.

• Life and accidental death & dismemberment (AD&D) insurance.

• Employee assistance programs and wellness resources.

• Eligibility for bonuses, equity, or other incentive programs, depending on the role.