Payor Analyst - Reimbursement HUB Services
Core
Manage payer information databases, maintain reimbursement guidelines, and support audit preparation for healthcare reimbursement operations.
Role type
Payor Analyst (Reimbursement Operations)
Builds
Payer databases, reimbursement guidelines, audit documentation
Domain
Healthcare / Reimbursement Operations
Deliverable
dashboards & analysis
Required skills
Database management, data validation, audit preparation, payer policy analysis, Microsoft Excel, Microsoft Access, medical terminology, insurance benefits knowledge, prior authorization processes, appeals procedures
Preferred skills
Pharmacy Benefit Management (PBM) experience, hospital environment experience, auditing or quality assurance experience, Medicare/Medicaid/TRICARE knowledge
Technologies
Microsoft Office (Excel, Access, Word, PowerPoint)
Responsibilities
Maintain and update payer information management system databases; Review, clean, and improve existing system files; Collect and validate payer-related insights from cross-functional teams; Monitor payer notices and incorporate updates into databases; Support Quality teams with audit preparation and documentation; Contribute to staff education and training initiatives; Partner with client representatives to monitor payer developments
Seniority
Mid-level, individual contributor