Note: The job is a remote job and is open to candidates in USA. Koya Medical, Inc. develops people-centric technologies for venous and lymphatic care. The Payer Analytics Manager analyzes payer data, coverage policies, contract performance, reimbursement outcomes, and operational workflows to support market access strategies, payer engagement, contract negotiations, and revenue optimization. The role also develops KPIs, dashboards, financial models, and automation solutions for market access and reimbursement stakeholders.
Responsibilities
- Analyze and maintain payer coverage policies and criteria to date
- Assess coverage policies and analyze the influence of utilization management on market access pull through
- Perform routine and ad hoc analyses of payer performance including outcomes from prior authorization, denials and appeals functions and identify trends
- Conduct in-depth analysis of payer contract performance and develop financial models to forecast revenue and support strategic pricing decisions during contract negotiations
- Monitor and report key performance indicators (KPIs) such as team productivity, prior authorization and appeal outcomes, reimbursement rates, and days sales outstanding (DSO) using scorecards and dashboards
- Evaluate authorization, appeal, and claims data to uncover performance trends, identify underpayments, and highlight opportunities for revenue optimization
- Translate complex data insights into clear, actionable presentations for both technical and non-technical audiences, including senior leadership
- Translate manual workflows into RPA automations with reportable outcomes
Skills
- Education: Bachelor's degree in a relevant field like Finance, Economics, Data Analytics, or Healthcare Administration
- Proficient in advanced Excel functions and reporting tools, with expertise in Power Automate, Power BI, Tableau, or other business intelligence platforms
- Analytical and technical skills: Strong abilities in financial modeling, data interpretation, trend analysis, and scenario modeling
- Domain knowledge: A solid understanding of healthcare payer contracting, reimbursement methodologies, provider payment structures, and healthcare-related data
- Communication skills: The ability to clearly explain complex financial and analytical concepts to both technical and non-technical audiences
- Problem-solving: Demonstrate critical thinking and a proactive approach to identifying and troubleshooting issues
- Collaboration: Proven ability to work effectively across multiple departments and build relationships with internal and external partners
- While performing the duties of this position, the employee is regularly required to talk or hear
- The employee frequently is required to use hands or fingers; handle or feel objects, tools, or controls
- The employee is occasionally required to stand; walk; sit; and reach with hands and arms
- The employee must occasionally lift and/or move up to 25 pounds
- Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus
- Background in healthcare reimbursement or medical device industry preferred
Benefits
- Base + bonus compensation package
- Competitive benefits program
- The role is full time, exempt and will work remotely.
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