Note: The job is a remote job and is open to candidates in USA. Action Behavior Centers is an autism therapy organization serving children with ASD through a growing community of clinicians and operators. The Payer Strategy Analyst owns the end-to-end lifecycle of case-by-case insurance contracts, including analyzing out-of-network referrals, negotiating reimbursement rates, securing service authorizations, and coordinating payer-related enrollment and documentation activities. The role serves as a bridge between payers and internal teams to support compliant onboarding and operational effectiveness.
Responsibilities
- Initiate Single Case Agreement (SCA) and Network Gap Exception processes in collaboration with internal ABC Teams (e.g. Authorization, Revenue Cycle, Ops, & Finance) and external Teams (e.g. Payers/Health Insurance Companies)
- Ability to advocate effectively and negotiate directly with Payers/major insurance carriers to secure acceptable reimbursement terms
- Correspondence and communication with Payers/major insurance carriers, including relationship building across the SCA lifecycle
- Exceptional verbal and written communication skills; ability to remain professional and empathetic when speaking with payers and families
- Coordinate and submit provider and group enrollment applications for new and existing markets
- Support new state and de novo market growth through responsibilities, including but not limited to: enrollment activities, ensuring accurate and timely setup with payers
- Track enrollment application status, follow up on payer requests, and resolve enrollment-related issues
- Review provider and group enrollment submissions for accuracy and completeness, identifying credentialing concerns and requesting appropriate follow-up information as needed
- Complete EFT and ERA enrollments and communicate confirmation to collaborating internal teams
- Work closely with the Credentialing Department to align enrollment and credentialing workflows
- Partner with contracting specialists to support group updates, demographic changes, and payer-related maintenance
- Act as a liaison between Credentialing and Revenue Cycle Management teams to support resolution of payer enrollment and setup issues
- Communicate with payers to respond to information requests and ensure timely enrollment completion
- Maintain accurate provider, group, and payer records across internal systems and databases
- Organize and maintain payer documentation, including Single Case Agreements Agreements (SCAs), enrollment records, and related materials
- Track renewal timelines, payer requirements, and compliance-related documentation for existing markets
- Establish, document, and follow enrollment processes and workflows appropriate to each payer and market
- Support continuous improvement efforts by identifying enrollment inefficiencies or recurring payer issues
- Assist with payer plan discovery and maintenance of payer-specific requirements, benefits, and market nuances as assigned
- Collaborate with internal teams including Credentialing, Contracting, Revenue Cycle, Finance, and Operations to support payer-related activities
- Assign and coordinate tasks with outsourced or external partners as appropriate to support enrollment activities
- Contribute to departmental projects and other related duties as assigned
Skills
- 3 years+ experience in RCM-based roles
- Single Case Agreement / Network Gap Exception / Contracting - required
- Deep understanding of out-of-network benefits, network adequacy laws, contract terms, and the behavioral health prior authorization lifecycle
- Proficiency or some experience with SalesForce, Zoho, or other project tracking systems
- Strong attention to detail and organizational skills
- Exceptional verbal and written communication skills; ability to remain professional and empathetic when speaking with payers and families
- Billing, AR - experience strongly preferred
- Understanding of ABA - experience preferred
- Experience in a billing company and/or large-scale healthcare organization - strongly preferred
Benefits
- 10 Days of PTO, 10 Paid Holidays, 2 Flex Days + More with Tenure
- Student Loan Repayment Employer Contributions
- Maternity/Paternity Award of up to $3,000 & FSA Options for Childcare
- Door Dash Pass and Regional Night of Honors
- Up to $600 Student Loan Repayment Options & Tuition Discounts
- Professional development: we want to pour into you as you pour into ABC
- Leadership opportunities: To be the best, we have to continually keep learning and you get to push yourself here to learn more and take on more responsibilities, and show what you can do!
- 401K Retirement Plans with company matching
Company Overview