Payer Analyst II

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration.

Position Summary

As an Analyst II on the Payer Accountability team, you will play a vital role in educating internal teams on payer guidelines, leading payer and internal preparation calls, conducting trend analyses, and mentoring junior analysts. Your responsibilities will include researching and interpreting complex contract terms to identify and escalate claim issues, ensuring that payers address any instances of non-compliance. Success in this role demands strong problem-solving abilities, an analytical and proactive mindset, a deep understanding of revenue cycle operations, and adeptness in resolving claims and issues effectively.

Essential Responsibilities

Perform and meet all Payer Analyst roles and responsibilities:

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Navigate and interpret payer guidelines and contracts.

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Research and compile documentation for outstanding AR resolution.

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Escalate claim issues with payers and stakeholders when necessary.

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Represent payer issues professionally to achieve optimal outcomes.

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Analyze data for payer trends and compliance.

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Follow guidelines for escalated claim submissions.

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Collaborate with leadership and teams to resolve and prevent escalations.

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Provide feedback to partners, clients, and departments.

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Identify root causes to improve AR collections and procedures.

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Manage complaints and solve moderately complex problems.

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Analyze payer responses to determine next steps for resolution.

In addition, you will be responsible for:

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Enhance recoveries by diagnosing and addressing the root causes of escalations.

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Skilled in identifying process improvement opportunities and effectively communicating insights to leadership.

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Resolve complex issues and complaints efficiently.

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Coordinate preparation calls with payers and internal teams to ensure effective communication and resolution.

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Lead payer-facing calls and communications, serving as the R1 representative to effectively drive discussions and ensure successful outcomes.

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Perform in-depth trend analysis to identify and address payer behavior and patterns.

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Mentor and provide guidance to junior analysts, fostering their professional growth and development.

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Serve as a subject matter expert in managed care contracts, with the ability to interpret and analyze complex payer contract language and apply insights to real-world situations effectively.

Skills

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Self-motivator with the ability to work in remote environments with minimal supervision.

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Analytical and problem solving/critical thinking skills with attention to detail and quality at the forefront.

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Proficiency in Healthcare Reimbursement Pricing Structure and Methodologies.

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Excellent working knowledge of Revenue Cycle operations with a specific focus on Inpatient and Outpatient Managed Care and Commercial Payers.

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Proficient in Microsoft Office Suite (Word, Excel, and Outlook).

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Ability to implement process improvements based on the directives of leadership.

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Ability to multi-task and manage various demanding assignments that, at times, may conflict.

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Ability to independently troubleshoot system challenges for resolution.

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Proficient written and verbal communication skills.

- Strong communication skills.

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Experience in facilitation and mentorship.

Other Qualifications

- Proficient computer skills required.

- Education and Experience

Education Level: High School Diploma
Experience Level: 5-7 years experience
License and Certification Level: No specific certification requirements

Additional Requirement