Senior Payer Performance Analyst

Full-time, 40 Hours/week Days Hybrid - Akron, OH

Summary:

The (Senior) Payer Performance Analyst supports payer performance strategy and analytics under the direction of the Director of Payer Analysis. This role is responsible for developing, maintaining, and distributing payer scorecards on a regular cadence to key stakeholders across the organization; monitoring payer issues and trends through participation in payer calls; facilitating escalation activities in alignment with standard work instructions; and tracking payer issues, escalation efforts, and associated financial impact. The analyst also supports strategic pricing initiatives by conducting market assessments, defining peer groups as directed, and identifying pricing opportunities where rates may be above or below market based on external review and other relevant factors. This individual partners with cross-functional teams to deliver actionable insights that support organizational goals.

Responsibilities:

1. Leads the development, enhancement, and maintenance of payer scorecards, ensuring alignment with organizational priorities and managed care strategy.
2. Synthesizes and communicates payer performance insights through regular scorecard reporting, clearly translating trends, risks, and opportunities into actionable recommendations for leadership.
3. Participates in and informs payer engagement activities, maintaining awareness of payer issues, policy changes, and market trends and proactively communicating implications to internal stakeholders.
4. Develops and maintains standardized payer guidelines and escalation frameworks, enabling consistent and effective management of complex claim issues across business units.
5. Interprets managed care contract terms and payer policies, compiling supporting documentation and leading resolution strategies for complex accounts receivable (AR) issues.
6. Facilitates and oversees payer issue escalation processes, ensuring alignment with organizational standards and driving timely, effective resolution of high-impact issues.
7. Partners with revenue cycle, finance, and operational leadership to optimize payer performance, mitigate risk, and improve net revenue outcomes.
8. Tracks and analyzes payer issues, escalation outcomes, and financial impact, leveraging data to inform prioritization, identify systemic trends, and recommend process improvements.
9. Supports strategic pricing and market analysis, including peer group identification, market assessments, and evaluation of pricing position relative to reimbursement and competitive benchmarks.
10. Executes high-priority analytical initiatives and special projects independently, managing competing priorities while delivering insights that support strategic and operational decision-making.

Other information:

Technical Expertise

1. Advanced experience in healthcare reimbursement analytics, including value-based reimbursement models and complex payment methodologies (e.g., fee-for-service, EAPG, APR-DRG, MS-DRG, APC, case rates), with the ability to assess financial and operational impact.
2. Advanced knowledge of managed care contract language and reimbursement structures, with demonstrated ability to interpret terms and apply them to financial modeling, variance analysis, and revenue optimization strategies.
3. Demonstrated ability to synthesize complex data and communicate insights effectively, translating analytical findings into clear, actionable recommendations for diverse stakeholders, including senior leadership.
4. Advanced problem-solving and critical thinking skills, with the ability to independently analyze complex reimbursement issues, identify root causes, and develop data-driven solutions.
5. Demonstrated ability to apply advanced analytical techniques, including trend analysis, financial modeling, and scenario analysis, to support strategic and operational decision-making.
6. Advanced proficiency in Microsoft Excel (e.g., complex formulas, XLOOKUP, pivot tables, data manipulation), with strong working knowledge of PowerPoint, Word, and Outlook to support analysis and executive communication.
7. Proficiency in data visualization and reporting tools (e.g., Power BI) and healthcare data platforms (e.g., Epic SlicerDicer, Strata or similar), with the ability to design dashboards and deliver insights that inform performance improvement and strategy. Education and Experience

1. Education: Bachelor's degree in data science, Statistics, Health Informatics, Public Health, or a related field. MBA/MHA/MPH/MHCM preferred.
2. Certification: Strata Jazz- IAR Pro Level 1 and ACH Internal- Fundamentals of Data & Analytics Certification to be completed within 3 months of hire.
3. Years of relevant experience: Minimum 7 years. a. Proven experience with statistical analysis, predictive modeling, and data visualization tools. b. Strong analytical and problem-solving skills with the ability to interpret complex data sets. c. In-depth knowledge of healthcare data sources, including claims, EHR, and patient registries. d. Excellent communication and presentation skills. e. Ability to work independently and manage multiple projects simultaneously. f. Familiarity with healthcare regulatory requirements and industry standards.
4. Years of supervisory experience: none.

Full Time

FTE: 1.000000

Status: Fixed Hybrid