Payer Operations Analyst

Black River Memorial Hospital•Black River Falls, WI

About The Position

Black River Health is looking for a driven, detail-focused professional ready to make a real impact on how we partner with payers and deliver care to our community. If you thrive at the intersection of data, process, and cross-functional collaboration, this is your opportunity to step into a role that shapes the financial and operational backbone of our organization. Your next career move starts here. Why This Role Matters As our Payer Operations Analyst, you’ll be the engine behind accurate payer setup, smooth onboarding, and seamless enrollment across our two-campus system. You’ll translate payer requirements into real operational workflows, solve complex issues, and ensure our teams have what they need to deliver outstanding care — all without direct supervisory responsibilities. This is a role for someone who loves problem-solving, building structure, and keeping a fast-moving organization aligned and compliant.

Requirements

Associate degree required; Bachelor’s preferred — or equivalent experience
4–6 years in payer operations, credentialing, enrollment, or managed care
Experience with commercial, Medicare, and Medicaid payers
Strong working knowledge of CAQH, PECOS, NPPES, payer portals, and RCM systems
Ability to analyze KPIs, identify trends, and drive process improvements
Excellent communication, organization, and cross-department collaboration skills
Commitment to regulatory and privacy compliance

Responsibilities

Payer Setup & Enrollment Lead all payer onboarding and enrollment activities for both campuses
Ensure both the facility and all healthcare providers are enrolled with commercial and government payers, completing all reenrollment and revalidation requirements on schedule
Maintain accurate provider data across CAQH, PECOS, NPPES, payer portals, and RCM systems
Ensure timely credentialing completion and payer configuration
Cross-Functional Collaboration Serve as the primary liaison between Revenue Cycle, Finance, Operations, Credentialing, and Payer Partners
Resolve issues related to claims, denials, authorizations, credentialing, and payer setup
Operational Execution Translate contract terms, reimbursement methodologies, and participation requirements into workflows and system updates
Support fee schedule updates, payer configuration, and compliance alignment
Performance Monitoring & Reporting Track KPIs, enrollment progress, and payer performance
Identify trends, risks, and revenue leakage
Prepare dashboards and reports to support leadership decision-making
Process Improvement Standardize and document processes through SOPs, process maps, and training materials
Troubleshoot complex operational issues, including enrollment delays, system errors, and reimbursement discrepancies