Payor Analyst - Reimbursement HUB Services

Accountabilities:: Manage and maintain payer information management system databases, ensuring the accuracy, completeness, and reliability of critical reimbursement information. Maintain and update referring healthcare professional files, insurance databases, payer processing guidelines, prior authorization requirements, appeal procedures, key contact information, and relevant payer documentation. Review, clean, and improve existing system files to ensure information remains accurate, consistent, and aligned with current reimbursement processes. Collect, validate, and consolidate payer-related insights from cross-functional teams, including HUB operations, field reimbursement, market access, and analytics. Serve as a central point of contact for gathering and sharing updates on payer policies, reimbursement requirements, and claims review processes. Monitor payer notices and communications received through various channels, assess their relevance, and incorporate applicable updates into the payer database. Ensure relevant departments and stakeholders are informed of payer policy changes, while maintaining an organized archive of notices and updates for future reference. Collaborate with operational teams to develop payer roadmaps that guide users toward the appropriate billing, prior authorization, and appeal documentation and procedures based on prescribed treatments. Support Quality teams with audit preparation by collecting, validating, and organizing documentation for internal and external audits, including onsite audits, Medicaid reviews, and Prescription Drug Event (PDE) audits. Prepare audit-related progress updates and presentations, communicating key findings and developments to clients during monthly and quarterly business reviews. Contribute to staff education and training initiatives by explaining departmental policies, reimbursement procedures, and best practices for improving first-submission success rates. Act as a subject matter expert for operational teams, helping educate clients and internal stakeholders on payer requirements and reimbursement best practices. Partner with client representatives to exchange information, monitor payer developments, and identify emerging reimbursement trends. Participate in payer focus groups and relevant stakeholder meetings to share insights, identify payer-specific nuances, and discuss evolving requirements. Provide ongoing recommendations, key learnings, and actionable insights to internal teams, leadership, and external clients. Work closely with leadership and Quality teams to communicate operational updates, reinforce process improvements, and ensure new learnings are consistently implemented. Support continuous improvement initiatives that strengthen reimbursement accuracy, operational efficiency, and overall service quality. Requirements: High school diploma or GED is required. At least 5 years of professional work experience. Previous experience in healthcare reimbursement, payer operations, Pharmacy Benefit Management (PBM), or hospital environments is strongly preferred. Experience in healthcare, medical reimbursement, or related fields, ideally including 1–3 years of auditing or quality assurance experience. At least 3 years of experience using Microsoft Office applications, with strong proficiency in Excel, Access, Word, and PowerPoint. Knowledge of healthcare insurance plans, including commercial and government payers such as Medicare, Medicaid, and TRICARE. Understanding of insurance benefits, reimbursement processes, prior authorization requirements, and appeals procedures. Familiarity with medical terminology and healthcare industry practices through 1–3 years of relevant experience, training, or an equivalent combination of education and professional experience. Strong analytical and organizational skills, with the ability to manage multiple assignments, establish priorities, and complete tasks independently with minimal supervision. Excellent attention to detail and accuracy, particularly when maintaining payer databases, reviewing documentation, and preparing audit materials. Demonstrated leadership capabilities and the ability to act as a subject matter expert, share knowledge, and support colleagues. Strong written and verbal communication skills, including the ability to interact professionally with internal teams, external business partners, and clients in person or by telephone. Proven ability to collaborate effectively across multiple departments and functions while maintaining productive working relationships. Excellent follow-up, accountability, and problem-solving skills, with a proactive approach to identifying and resolving operational challenges. Ability to adapt to changing payer requirements, manage competing priorities, and work effectively in a fast-paced healthcare environment. Benefits: Competitive salary. Fully remote working opportunities. Flexible working environment. Discretionary paid time off (PTO). Paid holidays. 401(k) retirement plan with employer matching contributions. Medical, dental, and vision insurance. Health Savings Account (HSA) and Flexible Spending Account (FSA) options. Telemedicine services, including virtual doctor appointments. Employee assistance programs. Wellness programs. Tuition reimbursement and professional development opportunities. Career growth and internal promotion opportunities. Adoption assistance. Short-term and long-term disability coverage. Life insurance. Employee discount programs.