Senior Payor Intelligence Analyst

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

📋 Description

• Develop and manage payor entity mapping, including hierarchies, families, subsidiaries, TPAs, PBMs, and delegated relationships.

• Acquire, analyze, and oversee medical policies, coverage criteria, government regulations, and fee schedules.

• Implement effective dating, provenance, and version control for policy documentation.

• Create delegated-relationship logic for prior authorization processes.

• Identify which entity is responsible for decisions related to specific plans, products, and services.

• Discover and monitor clinical content sources such as InterQual and NCCN.

• Manage contracting requirements and timelines for clinical content sources.

• Align prospect and customer payor data with Tennr's payor model.

• Transform repetitive manual tasks into a streamlined system.

• Lead projects from initial concept through to completion.

• Contribute to the growth and success of the company.

• Work collaboratively with engineering, clinical, and operations teams.

• Engage and connect with colleagues in the Hudson Square office, including quarterly travel to the location.

⛳️ Requirements

• Over 5 years of experience within the U.S. payor landscape.

• Comprehensive knowledge of Medicare, Medicare Advantage, Medicaid and MCOs, and commercial lines of business.

• Proficiency in payor structure, including payor families, subsidiaries, TPAs, PBMs, delegated entities, regional versus national plans, and self-funded versus fully insured arrangements.

• Experience in researching and interpreting payor policies, government guidance, fee schedules, or clinical guidelines.

• Background in reconciling conflicting sources.

• Proven ability to build taxonomies, frameworks, databases, or mapping systems.

• Excellent analytical skills and pattern recognition capabilities.

• Investigative aptitude to navigate ambiguous and incomplete information.

• Strong sense of ownership over a domain from start to finish.

• Exceptional communication abilities.

• Familiarity with SQL or similar data tools is advantageous.

• Capacity to work effectively within the U.S. payor landscape.

• Necessary work authorization or visa sponsorship status required.

🏝️ Benefits

• Equity.

• Bonus.

• Remote flexibility.

• Unlimited PTO.

• 100% paid health benefit options for employees.

• Employer-funded 401(k) matching.

• Competitive parental leave.

• Quarterly travel to Hudson Square office.