We are looking for an experienced Senior Payer/Provider Contract Analyst to support complex payer relations and reimbursement activities within a dynamic healthcare environment. In this role, you will independently investigate payer-related challenges, analyze reimbursement policies, and identify opportunities to improve revenue cycle performance. You will play a key role in resolving complex billing and reimbursement issues, supporting financial recovery, and strengthening relationships with external payers. Working closely with clinical teams, revenue cycle professionals, administrators, and compliance specialists, you will help ensure accurate reimbursement and operational efficiency. You will also provide strategic insights through financial reporting, trend analysis, and process improvement initiatives. This position offers an opportunity to influence payer outcomes while contributing directly to the financial performance of a large healthcare organization.
- Independently investigate, analyze, and resolve complex payer-related issues, including prior authorization challenges, claim denials, reimbursement disputes, and payer policy determinations.
- Identify reimbursement discrepancies and revenue recovery opportunities, helping improve financial performance and optimize revenue cycle processes.
- Analyze negotiated reimbursement rates, monitor payment variances, and interpret financial reports to track recoveries and identify emerging trends.
- Facilitate discussions and meetings with insurance payers, revenue cycle teams, senior administrators, providers, and other stakeholders to resolve complex financial and operational issues.
- Represent the organization in interactions with external payer representatives, managers, medical directors, and compliance professionals, using specialized reimbursement knowledge to achieve favorable outcomes.
- Develop, compile, analyze, and communicate reports on payer issues, financial recoveries, reimbursement trends, and operational performance to internal and external stakeholders.
- Track financial recovery initiatives through completion and communicate processes, findings, and results to Revenue Cycle Advisors and other relevant teams.
- Provide expert guidance and consultation to revenue cycle and business office staff on payer reimbursement policies, contract terms, benefit limitations, and payment methodologies.
- Identify opportunities to improve operational efficiency, strengthen reimbursement practices, and increase revenue through innovative recommendations and process improvements.
- Maintain accurate project records, issue documentation, and tracking activities using the designated issue management application.
- Stay informed about commercial and government payer reimbursement methodologies, regulatory requirements, coding standards, contract provisions, and changes in healthcare financial management.
- Advise senior leadership on payer-related developments and financial trends to support strategic planning, financial control, and analytical decision-making.
- Collaborate with compliance analysts, legal counsel, medical staff office managers, and credentialing teams to address provider enrollment, credentialing, and payer provider file issues.
- Contribute to the evaluation, development, and implementation of new systems and technologies supporting reimbursement and revenue cycle operations, including electronic health record platforms.
- Mentor, train, and support Analyst II colleagues through specialized projects, reporting activities, and knowledge-sharing initiatives.
- Lead and contribute to special projects involving reimbursement, payer relations, and healthcare finance, ensuring appropriate timelines, deliverables, and project plans.
- Support the development and implementation of payer relations policies, procedures, and operational guidelines.
Requirements:
- Bachelor's degree and at least 5 years of experience in medical practice billing, medical coding, medical terminology, or a related field. An equivalent combination of education and relevant professional experience may also be considered.
- Strong understanding of healthcare revenue cycle operations, medical billing processes, payer reimbursement methodologies, and provider contracting practices.
- Demonstrated ability to independently investigate and resolve complex payer issues, reimbursement discrepancies, prior authorization challenges, and claim denials.
- Knowledge of commercial and government insurance programs, payer policies, reimbursement regulations, contractual terms, and benefit structures.
- Understanding of CMS guidelines and American Medical Association (AMA) Current Procedural Terminology (CPT) standards is preferred.
- Strong analytical and problem-solving skills, with the ability to interpret financial data, identify reimbursement trends, evaluate payment variances, and recommend effective solutions.
- Experience preparing financial reports, monitoring revenue recovery, tracking payer issues, and presenting findings to management and cross-functional stakeholders.
- Proficiency in Microsoft Office applications, particularly Excel, for financial analysis, reporting, and data management.
- Familiarity with EPIC and Tableau reporting tools is preferred.
- Excellent written and verbal communication skills, with the ability to explain complex reimbursement matters clearly to clinical, administrative, financial, and external stakeholders.
- Strong organizational skills, attention to detail, and the ability to manage multiple projects, establish priorities, and meet deadlines.
- Proven ability to collaborate effectively with colleagues at all organizational levels, including senior management, physicians, revenue cycle professionals, and external payer representatives.
- Strong interpersonal, customer service, negotiation, and relationship management skills.
- Ability to exercise independent judgment, demonstrate initiative, and make informed recommendations in a complex and evolving healthcare environment.
- Experience mentoring colleagues, sharing technical knowledge, and supporting team development is an advantage.
Benefits:
- Competitive annual salary ranging from $61,000 to $85,400, depending on qualifications, experience, education, expertise, market conditions, and internal equity.
- Full-time, remote working arrangement.
- Standard 40-hour workweek.
- Day-shift schedule.
- Opportunity to contribute to significant revenue recovery and healthcare financial performance initiatives.
- Exposure to complex payer relationships, reimbursement strategies, and enterprise-level healthcare operations.
- Opportunities to collaborate with multidisciplinary teams and senior healthcare professionals.
- Professional development through specialized projects, reporting initiatives, and cross-functional collaboration.
- An inclusive and welcoming working environment that values equity, leadership, integrity, openness, respect, and accountability.
