Specialist, Revenue Cycle Systems

Summit Health • NJ

75d • $62,000 - $79,000

About The Position

The Payer Knowledge Systems Analyst supports the revenue cycle and managed care teams by ensuring accurate payer contract implementation, monitoring reimbursement performance, and analyzing variances between expected and actual payments. This role is critical in maintaining financial integrity, optimizing reimbursement, and supporting contract negotiation and compliance initiatives within the organization.

Requirements

• Associates degree preferred or equivalent experience.
• Ability to work in a fast-paced environment.
• Prior experience in a hospital, physician group, or healthcare payer setting.
• Familiarity with government and commercial payer policies.
• Exposure to contract modeling tools or data visualization software (e.g., Power BI, Tableau, Rivet).
• Prior experience with troubleshooting/problem resolution of contract adherence issues.
• In-depth knowledge of HIPAA, 837, 835, 270/271, 276/277, and other healthcare EDI standard formats.
• Working knowledge of UB04 and CMS-1500 claim forms.
• Working knowledge of ICD-10 and CPT codes.
• Detail-oriented & efficiency-minded; good at finding ways to improve processes and operations.
• Organized with the ability to design and maintain effective tracking systems.
• Must be technically savvy and comfortable using software, including, but not limited to MS Office, Insurance Portals, and Electronic Claims Submissions.
• High aptitude to learn new programs, system integrations, and business processes.
• Takes initiative to resolve situations and to accomplish projects actions and tasks.
• Excellent customer service skills with strong written and verbal communication skills.
• Strong work ethic with a proven track record of accuracy, dependability, and consistency.
• Must be able to think independently, have strong analytical, creative problem-solving skills with a continuous improvement mentality.
• Ability to gain the cooperation of others and work in a team environment in pursuit of company goals.
• Excellent organizational skills with the ability to manage multiple tasks and priorities.
• Ability to handle confidential & sensitive information.
• Professional attitude, demeanor, and work ethic.
• Strong customer relations and interpersonal skills.
• Ability to handle difficult situations tactfully and diplomatically solving problems.

Responsibilities

• Review and interpret payer and provider agreements, amendments, and fee schedules to ensure accurate setup in the contract management and billing system.
• Maintain a comprehensive database of payer contracts and rate tables, including updates for renewals, policy changes, and regulatory adjustments.
• Collaborate with IT and revenue integrity teams to validate correct loading of contractual terms in revenue cycle systems (e.g., Epic, Athena).
• Perform required maintenance and upkeep of the contract management system, Rivet, including the building of logic and downstream troubleshooting required when issues are identified.
• Perform detailed variance analysis to identify underpayments, overpayments, and billing discrepancies.
• Perform detailed system configuration analysis to identify system issues causing discrepancies within EMR and all downstream systems.
• Reconcile expected versus actual reimbursement using contract modeling and payment data.
• Support managed care and revenue integrity teams in validating payer performance and identifying opportunities for recovery or renegotiation.
• Develop and maintain contract performance dashboards and financial reports for leadership.
• Track payer compliance with agreed reimbursement terms, escalation procedures, and payment timelines.
• Assist in preparing financial impact assessments for proposed contract changes or new agreements.
• Work closely with contracting, billing, coding, and finance teams to ensure alignment between contract terms and revenue cycle operations.
• Support contract negotiation and renewal processes with data-driven insights.
• Communicate complex reimbursement and contractual information in a clear, actionable format for operational leaders.
• Maintain knowledge of the functional area and company policies and procedures.
• Proactively monitor manual processes with the intent to automate and optimize.
• Assist management with the execution and compliance with Standard Operating Practices (SOP’s) and Plans of Action.
• Gather parameters, perform analysis, implement solutions, and track outcomes to ensure accuracy of all transactions.
• Organize transaction flows between internal systems and continuously optimize manual processes.
• Create reports to monitor data accuracy and statistics, including review of the EMR systems to ensure proper rates are being used on the claims submitted to carriers for reimbursement.
• Track the resolution of the process and share knowledge with the team to maximize understanding and effectiveness.
• Provide support with documented follow-up as needed on Payer Calls.
• Identify data and/or conversion issues and proactively report issues to both internal and external clients.
• Maintain excellent relationships with 3rd party vendors.
• Additional duties and responsibilities as required and/or assigned.

Benefits

• Medical, Dental, Life, Disability, Vision, FSA coverages.
• 401k savings plan.

What This Job Offers

• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees