Contracts Payor Analyst

#REF!•Arlington, TX

1d•Hybrid

About The Position

Bring your passion to Texas Health so we are Better + Together. This is a Hybrid Position. Gain a sense of accomplishment by contributing to a teamwork environment. Receive excellent mentorship, comprehensive training, and dedicated leadership resources.

Requirements

Bachelor's Degree Business, Finance, Accounting, Healthcare Administration, Data Analytics, or related field
3 Years Decision support, financial analysis, healthcare pricing, managed care analytics, or revenue cycle to include SQL or relational database experience and/or reimbursement methodologies.
Proficiency in Excel, Access and SQL
Experience with pricing and modeling platforms such as EPIC, PMMC, Tableau, Power BI, Power Query, Alteryx or other healthcare pricing and claim systems.

Nice To Haves

Familiarity with government and commercial payor reimbursement methodologies.
Knowledge of hospital, ancillary, and physician coding systems.
Proficiency in Excel, Access and SQL
Experience with pricing and modeling platforms such as EPIC, PMMC, Tableau, Power BI, Power Query, Alteryx, or other healthcare pricing and claim systems is a plus.
Excellent written and verbal communication and strong collaboration skills.
Familiarity with government and commercial payor reimbursement methodologies.
Knowledge of hospital, ancillary, and physician coding systems.
Strong analytical and problem-solving skills, with ability to identify root causes of variance and interpret payor reimbursement methodologies.
Critical thinking skills, strong math and computer aptitudes, presentation skills.
Ability to manage multiple priorities in a fast-paced environment.

Responsibilities

Validate all payor contract loads, ensuring accurate reimbursement methodologies, escalator terms, carve-outs, and fee schedules across EPIC, StrataJazz, PMMC, and related tools.
Conduct comprehensive contract load audits and identify discrepancies between negotiated terms and system configuration.
Perform expected-to-actual reimbursement analysis by payor, entity, service line, and claim type.
Identify and quantify variances; conduct root-cause analysis for underpayments, overpayments, or contract misinterpretation.
Partner with Revenue Cycle and Payor Operations to validate underpayment trends and reconcile discrepancies.
Maintain databases and reporting structures to support continuous monitoring of contract compliance and financial outcomes.
Ensure data integrity and compliance with regulatory and THR data governance standards.
Deliver actionable insights by analyzing historical claims data, reimbursement trends, and competitive market dynamics to inform enterprise pricing strategy for hospitals, ancillaries and physicians.
Prepare dashboards and reports to support executive decision-making, including payor performance, service line, variance analysis, reimbursement trends, and pricing performance metrics.
Prepare monthly/quarterly/annual net revenue reports; identify and report on exceptions.
Monitor and report payor performance metrics, including reimbursement variance, contract yield, denial trends, and financial impact.
Track payor policy, regulatory updates, and operational requirements that affect payment performance or reimbursement calculations.
Collaborate with Payor Operations, Strategic Pricing, Revenue Cycle, ITS and SWHR to ensure accurate implementation of economic terms and rate changes.
Support internal audits, compliance reviews, and pricing validations related to reimbursement accuracy.
Participate in six-month lookback audits in partnership with Contract Compliance Auditors.
Provide analytical support for operational issue resolution, contract interpretation questions, and payor escalations.
Ensure compliance with industry regulations and Texas Health policies related to payor pricing.
Support strategic pricing initiatives, service-line analysis, margin optimization, value based care, and market competitiveness reviews.
Build and maintain dashboards visualizing payor performance, reimbursement variance, and trend analysis for leadership.
Support modeling for new services, alternative payment models, bundled arrangements, and pricing recommendations.
Assist with executive-level presentations, reporting, and strategic planning deliverables.
Complete additional projects and duties as assigned.