Payor Strategy Analyst

Spartanburg Regional Healthcare System•Spartanburg, SC

119d

About The Position

The Payor Strategy Operations Analyst supports the operational execution of payor strategy initiatives, focusing on interdepartmental coordination, price transparency research and analytics, payor policy research and analytics, and key payor strategy KPI reporting. The role connects Payor Strategy with internal departments, translating payor requirements, pricing data, contract terms, policy changes, denial trends, reimbursement performance, and other payor metrics into operational guidance, reporting, and actionable insights. The analyst supports payor relations, monitors reimbursement and policy trends, and helps identify risks and opportunities relevant to managed care strategy, contract performance, payor accountability, and organizational decision-making. The position is based in Spartanburg, South Carolina, within Spartanburg Regional Healthcare System's Payor Strategy and Relations team. It collaborates with teams including Revenue Cycle, Finance, Reimbursement, Compliance, Credentialing, Marketing, Communications, Clinical Operations, and operational leadership.

Requirements

Bachelor’s degree in Business, Finance, Healthcare Administration, Accounting, Public Health, Data Analytics, or a related field.
Strong organizational, analytical, research, communication, and stakeholder support skills.
Ability to manage multiple priorities, interpret complex payor information, identify operational and financial impacts, and communicate findings clearly to internal stakeholders.
Strong Excel skills.
Experience in healthcare, managed care, revenue cycle, reimbursement, payor relations, price transparency, policy research, analytics, or a related field is preferred; 2 to 4 years is the preferred experience range.

Nice To Haves

Working knowledge of managed care reimbursement methodologies, payor policies, hospital billing processes, coding concepts, and revenue cycle operations.
Experience with Power BI, Epic, Strata, contract management systems, claims and denials reporting, or database and reporting tools.

Responsibilities

Serve as an operational resource for internal departments regarding payor policies, reimbursement questions, contract-related inquiries, pricing information, and payor issue follow-up.
Coordinate with Revenue Cycle, Finance, Reimbursement, Compliance, Credentialing, Marketing, and operational leaders to resolve payor-related questions and issues.
Track and document internal requests, payor strategy email coordination, outstanding payor issues, follow-up items, and operational action steps.
Prepare materials for Joint Operating Committees, recurring payor meetings, and internal operational meetings, including issue logs, performance data, policy updates, and follow-up items.
Assist with management of the Payor Strategy Insurance Plan Website in coordination with Marketing and Communications.
Research, monitor, and analyze hospital price transparency data, including machine-readable files, payer-specific negotiated rates, service-line pricing, and peer market comparisons.
Validate price transparency data against contract terms, reimbursement methodologies, and internal pricing assumptions to identify discrepancies, trends, and potential compliance or financial risks.
Develop summaries, tracking tools, and reports supporting chargemaster pricing, market benchmarking, transparency compliance awareness, and leadership decision-making.
Monitor commercial, Medicare Advantage, Medicaid, and health exchange payor policies, reimbursement updates, medical policies, coding guidance, payment edits, and administrative requirements.
Analyze policy changes for potential impact on reimbursement, billing workflows, denials, prior authorization requirements, coding practices, and operational processes.
Maintain policy tracking tools, executive summaries, and issue logs to communicate material payor changes to relevant internal teams and leadership.
Develop, maintain, and distribute payor strategy KPI reports, including denial trends, authorization and referral metrics, claims payment performance, reimbursement variance tracking, underpayment trends, issue aging, appeal outcomes, and payor-specific operational scorecards.
Partner with Revenue Cycle, Finance, Reimbursement, and operational teams to validate KPI data, identify root causes of unfavorable trends, and escalate payor performance concerns.
Support Joint Operating Committee discussions, contract compliance monitoring, and negotiation strategy through payor performance analysis.
Contribute operational and research-based insights to payor strategy development, contract negotiations, amendments, and ongoing relationship management.
Perform additional duties as assigned.