Payer Strategy & Analytics Senior

US Acute Care Solutions • Virtual OH, OH

1d • $103,887 - $192,191 • Remote

About The Position

The Payer Strategy & Analytics Senior Finance Manager is the analytical lead for payor contracting, out-of-network reimbursement, and arbitration and litigation processes used to resolve payment disputes. The role provides financial tracking and data-driven decision support to scale out-of-network reimbursement through No Surprises Act (NSA) Independent Dispute Resolution (IDR), state arbitration, and litigation, and to optimize payor contract outcomes. Using CMS IDR Public Use Files and internal arbitration data, the position supports IDR entity selection, offer and rate strategy, and accounts-receivable follow-up to improve reimbursement yield. As a reimbursement subject matter expert, the role develops financial models and partners with Finance, Accounting, Legal, and Revenue Cycle leadership to ensure revenue projections and action plans are defensible and understood.

This is a remote position. The employee is regularly required to sit for prolonged periods and occasionally walk, stand, bend, stoop, and lift up to 15 pounds. Close visual acuity is required.

Requirements

• Bachelor’s degree in Business, Finance/Accounting, Economics, Health Policy, Informatics, or a related field, or equivalent experience.
• At least 5 years of reporting, analytics, and business operations experience, preferably in healthcare/provider settings.
• At least 2 years of direct experience in payor contracting analytics, out-of-network reimbursement, or NSA IDR/state arbitration analytics.
• At least 2–3 years of leadership experience.
• Working knowledge of the No Surprises Act, federal IDR process, qualifying payment amount (QPA), and state surprise-billing and arbitration frameworks.
• Ability to analyze large public and proprietary datasets, such as CMS IDR Public Use Files, and translate findings into clear strategy recommendations.
• Strong understanding of payor contracting, fee schedules, claims adjudication, remittance and EOB data, and emergency medicine professional billing and coding.
• Strong financial acumen and advanced analytical skills, including benchmarking, forecasting, and scenario and sensitivity modeling.
• Advanced Excel, PowerPivot, and a business intelligence tool such as Power BI or Tableau.
• Strong business acumen and interpersonal skills.
• Excellent oral and written communication and presentation skills, including explaining complex data to executives, attorneys, and non-technical partners.
• Sound judgment in handling confidential, privileged, and protected health information.
• Ability to work independently, manage complex projects, and achieve department goals.
• Superior time management, organizational, and problem-solving skills.

Nice To Haves

• MBA or master’s degree.
• Experience with SQL, Python, or R.
• Experience with emergency medicine or other hospital-based physician groups.
• Experience supporting litigation or arbitration with Legal and outside counsel.

Responsibilities

• Serve as the key analytical partner to Payor Contracting, Revenue Cycle/AR Follow-Up, Legal, Finance, Accounting, and Operations on in-network and out-of-network reimbursement strategy.
• Build financial models and recommendations for payor contract negotiations, renewals, and terminations, including quantifying in-network versus out-of-network impacts by payor and market.
• Ensure revenue recognition, budgets, and forecasts reflect expected outcomes from IDR, arbitration, and litigation in accordance with company policy.
• Own analytics for out-of-network reimbursement through federal NSA IDR and state arbitration, tracking volume, eligibility, deadlines, cycle time, win/loss rates, awards, and return on dispute cost.
• Analyze CMS federal IDR Public Use Files and internal IDR determination data to benchmark prevailing-party rates, offers versus awards, and award-to-QPA ratios by payor, service, geography, and IDRE.
• Evaluate IDRE selection and determination patterns, including fees, timeliness, and outcomes, and recommend selection and objection strategies.
• Develop and refine offer and rate strategies for IDR and arbitration submissions, including recommended amounts by service, payor, and market.
• Analyze, track, and report payor contract performance, including yield per encounter, rate benchmarks, rate escalators, and underpayments.
• Partner with AR Follow-Up and Revenue Cycle leaders to prioritize work queues, optimize open negotiation and IDR initiation timing, monitor payor compliance with awards, and identify yield-improving process changes.
• Provide data analysis, underpayment and damages modeling, and exhibits for payor litigation and award enforcement, working with Legal and outside counsel.
• Monitor and interpret regulatory, legal, and industry developments and communicate potential business impacts.
• Perform diligence revenue reviews of potential payor contracts and acquisitions, including out-of-network exposure and dispute history.
• Design and maintain dashboards, performance metrics, and ad hoc analyses; present clear, actionable insights and recommendations to business leaders.
• Develop and implement analytics and data-collection standards and processes to ensure dispute, claims, and contract data integrity.
• Perform other duties as needed.

Benefits

• Medical, dental, and vision insurance options
• Health savings accounts (HSA) and flexible spending accounts (FSA)
• 401(k) employee and employer contributions
• Paid time off, including vacation, sick leave, and company holidays
• Paid parental leave and family support benefits
• Short-term and long-term disability insurance
• Life and accidental death and dismemberment (AD&D) insurance
• Employee assistance programs and wellness resources
• Possible bonus eligibility, equity, or other incentive programs, depending on the role

What This Job Offers

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