HHAeXchange is the leading technology platform for home and community-based care. Founded in 2008, HHAeXchange was born out of an idea to create a fully comprehensive end-to-end homecare solution to help people who are aging or have disabilities thrive in their homes and communities. Our employees are passionate about transforming the healthcare space by building the only homecare ecosystem that fully connects patients, personal care providers, managed care organizations, and states.
The Payer Integration Solutions Analyst implements, maintains, and optimizes home care revenue cycle solutions with a focus on payer integrations and billing configuration. The role interprets payer business and technical requirements, translates them into scalable configurations, and independently manages assigned work through testing and production readiness. It partners across Implementation, Product, Engineering, Operations, and client-facing teams to support accurate data exchange and successful payer onboarding.
To perform this job successfully, an individual must be able to perform each essential job duty satisfactorily with or without reasonable accommodation. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential Job Duties
Gather, analyze, validate, and document customer, payer, business, and technical requirements, and translate payer specifications and companion guides into scalable configurations and integration solutions.
Independently own assigned payer integration and configuration work from requirements definition through testing, validation, and production readiness.
Configure and maintain payer-specific billing rules, claim submission logic, enrollment requirements, reimbursement workflows, and related system integrations.
Analyze and troubleshoot implementation and production issues; identify root causes; evaluate alternatives; and recommend and implement appropriate corrective actions within the role's scope.
Partner with Implementation, Product, Engineering, Operations, payer, and client-facing teams, and support Senior Solution Analysts on complex requirements, escalations, and broader implementation efforts.
Execute testing, validation, and quality assurance activities to confirm configurations and integrations meet documented requirements and expected outcomes.
Support payer onboarding, production-readiness activities, enhancement requests, and ongoing optimization of payer configurations and integrations.
Monitor and maintain payer configurations and integrations to support performance, accuracy, and compliance with payer requirements.
Create and maintain requirements, configuration decisions, test results, operating procedures, internal tools, training materials, and best-practice documentation, and provide knowledge transfer.
Serve as a resource who bridges technical, operational, payer, and customer requirements while meeting service-level agreements, delivery standards, and internal procedures.
Other Job Duties
Other duties as assigned by supervisor or HHAeXchange leader.
Travel Requirements
Travel up to 10%, including overnight travel
Required Education, Experience, Certifications and Skills
Four or more years of relevant experience in healthcare revenue cycle, payer operations, claims processing, healthcare technology, healthcare data integration, or healthcare software implementation.
Working knowledge of Medicaid and managed care organization revenue cycle and payer processes, including claim submission, payer responses, reimbursement, rejections, and denials.
Working knowledge of healthcare electronic data interchange and X12 standards, including 837, 835, 270/271, and 276/277 transactions.
Experience interpreting payer specifications, companion guides, implementation requirements, and data elements; documenting business and technical requirements; and translating them into configuration or integration requirements.
Experience working with configuration-driven software platforms and managing multiple implementation or configuration activities through completion.
Strong analytical and troubleshooting skills, including the ability to identify root causes, evaluate alternatives, and determine appropriate next steps.
Knowledge of common healthcare integration methods and technologies, including secure file transfer protocol and application programming interfaces.
Strong written and verbal communication, organization, attention to detail, and the ability to ask effective discovery questions, challenge assumptions constructively, make recommendations, prioritize work, and collaborate across functions.
Experience with work-management and documentation tools such as Jira, Salesforce, Confluence, or SharePoint, and the ability to independently own assigned responsibilities within a cross-functional delivery model.
Ability to work on-site three days per week in the New York, Miami, or Bloomington office, with in-office requirements subject to change based on business needs.
Preferred experience includes home care or home care technology, healthcare software as a service, Health Level Seven or Fast Healthcare Interoperability Resources standards, or work with state Medicaid agencies, home care providers, or clearinghouses.
Willingness to explore and adopt AI tools responsibly to enhance productivity and innovation in your role.
The base salary range for this US-based, full-time, and exempt position is $70,000-80,000/yr, not including variable compensation. An employee’s exact starting salary will be based on various factors including but not limited to experience, education, training, merit, location, and the ability to exemplify the HHAeXchange core values.
This is a benefits-eligible position. HHAeXchange offers competitive health plans, paid time-off, company paid holidays, 401K retirement program with a Company elected match, including other company sponsored programs.
HHAeXchange is an equal-opportunity employer. The Company offers employment opportunities to all applicants and employees without regard to race, color, religion, national origin, sex, sexual orientation, gender identity or expression, age, disability, medical condition, marital status, veteran status, citizenship, genetic information, hairstyles, or any other status protected by local or federal law.
