Payer Analytics Manager

About the role

Koya is looking for curious and passionate individuals to join a fast-paced team transforming venous and lymphatic care through innovative, people-centric technologies that improve lives and empower self-care. This role is instrumental in analyzing payer data to shape and refine strategies for market access, payer engagements, contract negotiations, and reimbursement. The Payer Analytics and Insights Manager will leverage quantitative and qualitative insights to drive informed decision-making, optimize business processes, establish key performance indicators (KPIs), and uncover growth opportunities.

This is a full-time, exempt, remote position reporting to the Director of Reimbursement Operations.

Responsibilities

• Analyze and maintain up-to-date payer coverage policies and criteria.
• Assess coverage policies and analyze the influence of utilization management on market access.
• Perform routine and ad-hoc analyses of payer performance, including outcomes from prior authorization, denials, and appeals functions, and identify trends.
• Conduct in-depth analysis of payer contract performance and develop financial models to forecast revenue and support strategic pricing decisions during contract negotiations.
• Monitor and report KPIs such as team productivity, prior authorization and appeal outcomes, reimbursement rates, and days sales outstanding (DSO) using scorecards and dashboards.
• Evaluate authorization, appeal, and claims data to uncover performance trends, identify underpayments, and highlight opportunities for revenue optimization.
• Translate complex data insights into clear, actionable presentations for both technical and non-technical audiences, including senior leadership.
• Translate manual workflows into RPA automations with reportable outcomes.
• Actively partner with commercial analytics to integrate a clear payer perspective into the overall commercial process (e.g., from sales order to collections outcomes).
• Collaborate with cross-functional teams to ensure strategic alignment with organizational objectives.
• Analyze workflows for manual processes to improve efficiency and identify automation opportunities.

Requirements

• Bachelor’s degree in a relevant field such as Finance, Economics, Data Analytics, or Healthcare Administration.
• Background in healthcare reimbursement or the medical device industry preferred.
• Proficient in advanced Excel functions and reporting tools, with expertise in Power Automate, Power BI, Tableau, or other business intelligence platforms.
• Strong understanding of healthcare payer environments, including Medicare Fee for Service, Medicare Advantage, Commercial, Medicaid, and Managed Medicaid.

Skills

• Analytical and technical skills: Strong abilities in financial modeling, data interpretation, trend analysis, and scenario modeling.
• Domain knowledge: Solid understanding of healthcare payer contracting, reimbursement methodologies, provider payment structures, and healthcare-related data.
• Communication skills: Ability to clearly explain complex financial and analytical concepts to both technical and non-technical audiences.
• Problem-solving: Critical thinking and a proactive approach to identifying and troubleshooting issues.
• Collaboration: Proven ability to work effectively across multiple departments and build relationships with internal and external partners.
• Core competencies: Communication & cultural competence, initiative & critical thinking, flexibility & adaptability, planning & organization, teamwork & collaboration.

Tools and Technology

• Google Suite
• Microsoft Office Suite
• Adobe
• Salesforce CRM

Physical Requirements and Work Environment

The employee is regularly required to talk or hear and frequently uses hands or fingers to handle or feel objects, tools, or controls. Occasionally, the employee may stand, walk, sit, and reach with hands and arms, and must lift and/or move up to 25 pounds. Specific vision abilities required include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is usually low to moderate.

Pay

The pay range for this role is $125,000 – $130,000 USD per year.