Payer Contract and Reimbursement Analyst Full Time Days

East Tennessee Children's Hospital • Koppel, PA

7d

About The Position

The Payer Contract and Reimbursement Analyst supports payer strategy, contract management, reimbursement analysis, and operational issue resolution across hospital, physician, ancillary, and specialty service lines. This role blends contract analytics, Epic contract management support, fee schedule maintenance, denial and underpayment analysis, and reporting functions to improve reimbursement accuracy, strengthen payer performance, and support organizational revenue goals. The position serves as a key liaison among payer relations, revenue cycle, business analytics, operational leaders, and managed care organizations. Requires a strong combination of analytical, communication, and leadership skills, along with a thorough understanding of healthcare operations and managed care principles from both the payer and provider perspectives.

Requirements

• Bachelor’s degree in business, finance, healthcare administration, or a related field preferred.
• Three years of healthcare, managed care, payer contracting, revenue cycle, healthcare analytics, or related experience required.
• Epic Resolute Hospital Billing and/or Professional Billing
• Expected Reimbursement Contract certification preferred or ability to obtain within a defined onboarding period.
• Strong knowledge of managed care contracting, payer reimbursement methodologies, and payer-provider operations.
• Working knowledge of hospital, professional, and ancillary fee schedules and reimbursement terminology, including CPT, HCPCS, DRG, APC, revenue codes, and claim denial workflows.
• Understanding of payer rules, provider manuals, and regulatory updates affecting reimbursement and contract performance.
• Ability to interpret contract language and translate reimbursement methodologies into operational and analytical workflows.
• Experience with Epic contract management, expected reimbursement tools, or comparable contract modeling systems.
• Ability to mine and manipulate data from multiple systems while ensuring integrity and accuracy.
• Advanced Excel skills, including complex formulas, modeling, reconciliations, and reporting tools.
• Strong analytical, critical thinking, and problem-solving skills.
• Excellent written, verbal, and interpersonal communication skills.
• Ability to manage multiple priorities, work independently, and collaborate effectively across departments.
• Strong attention to detail, sound judgment, and timely responsiveness in a fast-paced environment.

Nice To Haves

• Expected Reimbursement Contract certification preferred or ability to obtain within a defined onboarding period.

Responsibilities

• Support negotiation of payer agreements across hospital, physician, behavioral health, home health, surgery center, and other applicable service lines by providing analysis, modeling, and contract interpretation to leaders responsible for negotiations.
• Interpret payer contract terms, payment methodologies, and reimbursement logic, and translate contract language into clear operational and analytical workflows to ensure accurate implementation and compliance.
• Build, configure, test, and maintain payer contract structures and expected reimbursement logic within Epic Contract Management (Hospital and Professional Billing) or related systems, ensuring accurate reimbursement calculations.
• Maintain annual contract escalators and fee schedules for hospital, professional, and ancillary providers; ensure timely updates are reflected in all related analyses and shared with internal matrix partners in a timely manner.
• Perform contract modeling, reimbursement analysis, and payment variance reviews to identify financial risks, underpayments, missed revenue opportunities, and areas for revenue optimization.
• Analyze contract performance by comparing actual payments to expected reimbursement, and research and resolve payer denials, underpayments, bundling issues, and other payment discrepancies.
• Conduct ongoing payer monitoring, including review of payer newsletters, provider manuals, bulletins, and regulatory communications, and communicate operational impacts and required follow-up to stakeholders.
• Partner with revenue cycle, business office, business analytics, credentialing, and operational leaders, as well as payer representatives, to resolve reimbursement and contract-related issues and support joint operating committee activities.
• Provide consultative support to leadership and operational teams by delivering ad hoc analyses, insights on payer performance, denial trends, reimbursement changes, and financial improvement opportunities.

Benefits

• Compassion – We imagine what others are going through, work to alleviate suffering, and create joy whenever possible.
• Ownership – We take pride in our work, act with integrity, and feel personal responsibility for achieving our mission.
• Respect – We listen, understand, and communicate openly and politely. We recognize our diverse strengths.
• Excellence – We set high standards for performance in delivering the safest patient care. We give extraordinary and meaningful experiences to our patients, their families, team members, and the community we serve.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level