Payor Strategy and Relations Analyst

Spartanburg Regional Healthcare System • Spartanburg, SC

7d • Onsite

About The Position

The Payor Strategy Operations Analyst supports the operational execution of payor strategy initiatives with a primary focus on interdepartmental coordination, price transparency research and analytics, payor policy research and analytics, and key payor strategy KPI reporting. This role serves as a key resource between Payor Strategy and internal departments, helping translate payor requirements, pricing data, contract terms, policy changes, denials trends, reimbursement performance, and other payor metrics into clear operational guidance, reporting, and actionable insights. The position supports ongoing payor relations activities, monitors emerging reimbursement and policy trends, and helps identify risks and opportunities that inform managed care strategy, contract performance, payor accountability, and organizational decision-making.

Requirements

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

Nice To Haves

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

Responsibilities

• Serve as a key 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 support timely resolution of payor-related questions and issues.
• Track and document internal requests, payor strategy email coordination, outstanding payor issues, follow-up items, and operational action steps to ensure consistent communication and accountability.
• Assist with preparation for Joint Operating Committees, recurring payor meetings, and internal operational meetings by organizing 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 reporting to support strategic 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 to assess 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 support timely communication of material payor changes to Revenue Cycle, Finance, Clinical Operations, Compliance, and Payor Strategy leadership.
• Develop, maintain, and distribute key payor strategy KPI reporting, 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 to support Joint Operating Committee discussions, contract compliance monitoring, and negotiation strategy.
• Contribute operational and research-based insights to support payor strategy development, contract negotiations, amendments, and ongoing relationship management.
• Perform additional duties as assigned.

Benefits

• Opportunity to support payor strategy, reimbursement performance, and operational decision-making within a respected, mission driven health system.
• Collaborative environment where your research, analytics, and operational coordination directly support patient care and organizational success.
• Meaningful work at the intersection of managed care, revenue cycle, finance, compliance, and healthcare operations.
• Growth potential within a large and stable healthcare organization.

What This Job Offers

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