Payer Performance Analyst

 About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.

JOB SUMMARY:

The Payer Performance Analyst will be responsible for evaluating, analyzing, and improving payer performance and payer relationships. This role will assist CorroHealth clients in ensuring that payers are adjudicating and paying according to their contract guidelines. This includes analytics and tracking of denials, escalation inquiries and responses, reimbursement levels and claims/appeals data. This role will leverage data analytics to assess payer performance and provide actionable insights to enhance the effectiveness of payer contracts and strategies. The Analyst will represent the client at monthly payer meetings along with Revenue Cycle leaders. The ideal candidate will be skilled in data analysis, contract management, and possess a strong understanding of healthcare payer processes.
**This position is HYBRID in Chicago, IL**
MUST HAVE:
-Government Payer experience - specifically IL Medicaid
-Leadership skills/experience
-Hospital Billing experience

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

ESSENTIAL JOB FUNCTIONS:

• Analyze large volumes of hospital data and provide weekly/monthly reporting of payer denials, trends and behaviors with data analytics tools. Conduct root-cause analysis of payer denials and trends. Produce ad-hoc reports as needed.
• Develop and maintain regular payer escalation spreadsheets, master files of escalations and payer guidelines. Submit spreadsheets and necessary documentation to meet payer deadlines for monthly meetings. Handle Revenue Cycle project management as needed.
• Reconcile payer escalation and system WQs to keep abreast of current payer inventories within the AR, and ensure proper KPIs. Create and maintain master file of payer guidelines.
• Serve as a key representative in payer communications, claim negotiations and meetings. Take and maintain minutes of payer meetings and records of payer communications.
• Identify patterns, discrepancies, and opportunities to improve claim submission and follow-up processes in relation to payer trends to mitigate denials and grow cash flow.
• Monitor payer compliance with contracted terms, including reimbursement schedules and payment accuracy.
• Communicate findings to senior leadership, recommending actionable steps to optimize payer performance, accelerate cash, and improve the clean claim rate.
• Keep abreast of industry trends, payer policy changes, and healthcare regulations that may impact payer performance.

Required Qualifications

Education:
 

• Some college or equivalent experience. Area of study may include:
• Business, Informatics, Data Analytics
• Finance, Accounting, Healthcare Administration or related field

Experience:

• 3+ years of experience working with data in a healthcare environment or healthcare financial management
• 2+ years working with Government and Commercial payers or equivalent years of experience with payer contracting
• Advanced level proficiency with Microsoft Excel require
• Some college or equivalent experience. Area of study may include: Business, Informatics, Data Analytics, Finance, Accounting, Healthcare Administration or related field

Other Helpful Education or Experience:

Proficient in Microsoft Excel, including advanced functions and pivot tables.

• Bachelor’s Degree Preferred
• Epic, Meditech or other EMR experience preferred
• Experience with Illinois Medicaid payers preferred
• SQL or other database software experience preferred

Knowledge, Skills and Abilities

• Acute attention to detail and strong analytical skills (required)
• Strong understanding of Revenue Cycle, Commercial and Government Payers
• Strong written and verbal communication skills
• Ability to employ critical thinking skills and work independently while also working well within a team environment
• Receptiveness to differing views and ideas with the ability to apply industry-specific concepts
• Highly adaptable to changing circumstances and/or directives in day-to-day priorities
• Ability to perform well on frequent repetitive tasks while continually improving skills and competencies
• Comfortable in faced paced working environment
• Ability to manage and complete short- and long-term projects
• Ability to set and meet deadlines
• Willingness to travel occasionally

Work Environment:

• Hybrid position requiring on-site attendance as needed – most likely a few days a week. Position can change to 100% on-site as business need or client dictates.
• Good internet connection needed to work from home.
• Occasional travel may be required for training, conferences, etc.

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.