Payor Operations Analyst - Remote

Overview

The Payor Operations Analyst serves as a source of knowledge for designated payor operations and performance, translating data into meaningful information that supports decision-making and drives performance improvement.

In Short

• Complete position responsibilities within the appropriate time frame while adhering to quality standards.
• Influence payor policy changes to impact product coverage.
• Track outcomes of payment resolutions, appeals, and negotiated claims.
• Analyze payor behaviors, systems, and processes.
• Research complex benefits and insurance verification.
• Monitor and validate adherence to policies and procedures.
• Coordinate with management to understand trends affecting payor performance.
• Manage denial management for designated payors.
• Communicate payor performance to related teams.
• Work with PHI on a regular basis.

Requirements

• Experience in data analysis and payor operations.
• Strong analytical skills to identify trends and opportunities.
• Ability to manage multiple projects simultaneously.
• Excellent communication skills for presenting information.
• Familiarity with insurance verification processes.
• Experience in auditing and compliance.
• Proficiency in using various technologies for data access.
• Ability to work collaboratively with cross-functional teams.
• Knowledge of state statutes and laws related to payors.
• Strong problem-solving skills.

Benefits

• Comprehensive medical, dental, vision, life, and disability plans.
• Free testing for employees and their immediate families.
• 401k benefits and commuter benefits.
• Generous employee referral program.
• Pregnancy and baby bonding leave.