Market Access Payor Analyst

Market Access Payor Analyst focused on profiling, researching, and resolving reimbursement issues for assigned payors, products, or lines of business.

Responsibilities

• Formulate and develop 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 trends, opportunities, and risks for all payors and products.
• Compare payor reimbursement patterns based on medical policies, contract language, authorization requirements, and patient benefits.
• Research complex benefits and insurance verification using various internal and external systems and portals.
• Investigate designated payors' literature and agencies; stay current on new indicators such as state statutes, laws, and other requirements.
• Develop strategies to improve reimbursement and reduce denials for assigned payors based on trends and analysis findings.
• Identify areas of opportunity for process improvements, automation, and efficiencies.
• Create management reports, custom dashboards, and visualizations.
• Initiate and support projects, initiatives, solutions, and other change management efforts.
• Conduct complex trend reviews, forecasting, sensitivity analysis, what-if scenarios, and other analyses.
• Partner with multiple internal cross-functional teams and manage multiple product projects simultaneously.
• Present information, analysis, updates, financial risks, and recommendations to specific audiences.
• Perform analysis of operational, production, financial, and other data.
• Analyze 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, and unstructured data to discover insights and collaborate with business partners to deliver business value.
• Participate in weekly meetings to review key metrics, workflows, trends, payor performance improvement opportunities, and strategies.
• Work with PHI regularly in both paper and electronic form; access various technologies to perform job duties.

Requirements

• Bachelor’s Degree in a 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.

Skills

• Proficiency with medical or claim billing systems, Microsoft Excel, reporting software, and basic procedure coding knowledge.
• Experience with Power BI and SQL is desired.
• Knowledge of medical terminology, abbreviations, healthcare 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 trends clearly and concisely.
• Ability to independently solve complex problems using critical thinking skills.
• Maintain confidentiality of sensitive information.
• Strong 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.
• Requires the ability to use a computer keyboard, communicate over the telephone, and read printed material.

Pay

Remote USA: $90,000—$112,500 USD. Actual compensation is based on factors unique to each candidate, including skill set, experience, certifications, and location.

Benefits

• Comprehensive medical, dental, vision, life, and disability plans for eligible employees and their dependents.
• Free testing for Natera employees and their immediate families, plus fertility care benefits.
• Pregnancy and baby bonding leave.
• 401k benefits.
• Commuter benefits.
• Generous employee referral program.