The Market Access Payor Analyst is responsible for profiling, researching, and resolving reimbursement issues for assigned payors, products, or lines of business. This position performs analysis, identifies trends, presents opportunity areas, and prioritizes initiatives for payment and performance improvement. Using data analytics, they derive logical conclusions and forecasts from implementing strategies that can improve business performance.

Primary Responsibilities:

● Formulates and develops presentations for project analysis needs from Finance, Billing, Market

Access, Product Leads, and other teams as required.

● Identify functions and barriers that affect ASP and revenue including identifying trends,

opportunities, and risks for all payors and products.

● Compares payor reimbursement patterns based on medical policies, contract language,

authorization requirements, and patient benefits.

● Researches complex benefits and insurance verification using various systems and portals

internal and external.

● Investigate designated payors' literature and agencies, and stay current on new indicators, such

as state statutes, laws, and other requirements.

● Develops strategies to improve reimbursement and reduce denials for assigned payors based on

trends and analysis findings.

● Identifies areas of opportunities for process improvements, automation, and efficiencies.

● Creates management reports and custom dashboards & visualizations.

● Initiates and supports projects, initiatives, solutions, and other change management.

● Conducts complex trend review, forecasting, sensitivity analysis, what-if scenarios, and other

analyses.

● Partner with multiple internal cross-functional teams and successfully manage multiple product

projects simultaneously.

● Presents information, analysis, updates, financial risks, and recommendations to a specific

audience.

● Performs analysis of operational, production, financial, and other data.

● Analyzes payor behaviors, systems, and processes in reimbursement to optimize performance.

● Ensure data integrity and control over business processes by developing data management best

practices.

● Operationalize business intelligence solutions to highlight strengths and opportunities to meet

organizational strategies, objectives, and goals.

● Analyze large data sets of structured, semi-structured unstructured data to discover data insights

and collaborate with business partners to deliver business value.

● Participates in weekly meetings to review key metrics, workflows, trends, payor performance

improvement opportunities, and strategies.

● This role works with PHI regularly both in paper and electronic form and has access to various

technologies to access PHI (paper and electronic) to perform the job.

Qualifications:

● Bachelor’s Degree healthcare-related field of study or equivalent experience.

● Minimum of 5 years of experience in revenue cycle or claim analysis

● Project management experience preferred.

● Knowledge of CPT/HCPCS. ICD-10, modifier selection, and UB revenue codes.

Knowledge, Skills, and Abilities:

● Proficiency with medical or claim billing systems, Microsoft Excel, reporting software, and basic

procedure coding knowledge.

● Experience with PowerBi and SQL is desired.

● Knowledge of medical terminology and abbreviations, and health care nomenclature and systems.

● Strong communication (verbal and written), organizational, problem-solving, and team player

skills.

● Knowledge of the appeal process and procedures.

● Ability to navigate across multiple customer demands and balance competing priorities

successfully.

● Ability to analyze, identify, and articulate identified trends and report trends succinctly clearly, and

concisely.

● Ability to independently solve complex problems using critical thinking skills.

● Maintains confidentiality of sensitive information.

● Analytical skills required.

● Ability to develop, implement, and produce complex analyses and reports.

Physical Demands & Work Environment:

Duties are typically performed in a remote office setting. This position requires the ability to use a computer keyboard, communicate over the telephone and read printed material.