Analyst, Revenue Cycle Payor Knowledge

Summit Health•Remote - New Jersey, NJ

5d•$64,100 - $80,200

About The Position

The Revenue Cycle Payor Knowledge Analyst will support the Revenue Cycle Payor Knowledge Team by interpreting and analyzing payer contract terms and reimbursement methodologies. The role includes reviewing payer contract language to create and maintain accurate fee schedules, identifying discrepancies between contracted terms and actual reimbursements, and analyzing data to identify opportunities to maximize reimbursements through payer negotiations, projects, and trends impacting the organization’s revenue. This position will collaborate closely with various internal teams, including Revenue Cycle Management, clinical leaders, application vendors, and SHM Revenue Cycle Systems and L&D teams.

Requirements

Strong analytical skills to reconstruct multi-step processes and correct sources of error.
Extensive knowledge of Revenue Cycle applications, including updates and enhancements.
Basic understanding of medical billing, including charge entry, EOB/remittance review, payment posting, and reconciliation practices.
Excellent verbal and interpersonal communication skills, with the ability to explain problems, solutions, and changes effectively.
Proficiency with computer systems and the ability to quickly adapt to new programs and websites.

Nice To Haves

Ability to interpret contract language and manage contract database updates.
Advanced analytical and research skills with strong attention to detail and the ability to manage multiple complex contracts simultaneously.
Industry certifications (e.g., CSPR, CRCR, CHAM, CHFP, FHFMA, FACHE) are a plus.
Knowledge and experience with various practice billing software systems, including understanding the workflow, processes, and billing procedures.
Familiarity with clinic, provider groups, and hospital revenue cycle and insurance payment methodologies.
Expertise in payer contracts, insurance types, and related billing and reimbursement policies.
Strong communication, problem-solving, and organizational skills.
Ability to manage payer contract, fee schedule, and analysis responsibilities across multiple business units.
Initiative to stay current with evolving billing practices and share knowledge with the team.
Knowledge of state, federal, and commercial payer reimbursement rules, policies, and methodologies.

Responsibilities

Manage the contract management tool, Rivet.
Oversee SHM Revenue Cycle fee-related tablespaces.
Support prioritization and implementation of system changes and updates.
Troubleshoot issues and inquiries from end users.
Coordinate and participate in project task deliverables.
Prepare and attend payer meetings.
Review, interpret, extract, and organize key information from payer contracts and amendments into the Payer Contract Matrix.
Create, maintain, and validate fee schedules based on contract payment sources and reimbursement rates.
Analyze reimbursement data to identify discrepancies, payer trends, and opportunities for maximizing reimbursement.
Research payer contract documentation and payer websites (e.g., provider manuals, billing policies) to ensure contract compliance and reimbursement integrity.
Communicate identified opportunities and trends, both internally and externally, with data support.
Compile reports for RCM team members to review unfavorable claim outcomes, pursue recovery of underpayments, or submit corrected claims.
Initiate contact with payers to validate contracted rate discrepancies.
Collaborate with the Payor Knowledge team to resolve fee schedule errors, load new codes, and map payers.
Work with product and technology teams to develop new technology solutions or enhance existing software.
Prepare client-facing reports and special projects related to contracts and fee schedules, adhering to company branding and templates. Reports may include Charge Master Analysis, Quarterly Payer Scorecard Reports, Claim Analysis Reports, and Underbilling Alerts.