Note: The job is a remote job and is open to candidates in USA. US Acute Care Solutions (USACS) is seeking a Payer Strategy & Analytics Senior Finance Manager to lead analytics for payor contracting, out-of-network reimbursement, and payment-dispute resolution. The role develops financial models, tracks arbitration and litigation outcomes, and partners with Finance, Legal, and Revenue Cycle leaders to guide reimbursement strategy and revenue forecasts.
Responsibilities
- Serves as the key analytical partner to Payor Contracting, Revenue Cycle/AR Follow-Up, Legal, Finance, Accounting, and Operations on in-network and out-of-network reimbursement strategy
- Builds financial models and recommendations to support payor contract negotiations, renewals, and terminations, including quantifying the impact of in-network versus out-of-network scenarios by payor and market
- Ensures revenue recognition, budgets and forecasts are reflective of expected outcomes from IDR, arbitration, and litigation, in accordance with the Company’s revenue recognition policy
- Owns the analytics supporting out-of-network reimbursement through the federal No Surprises Act IDR process and state arbitration programs; tracking volume, eligibility, filing deadlines, cycle time, win/loss rates, award amounts, and return on dispute cost
- Analyzes the CMS federal IDR Public Use Files and the group’s own IDR determination data to benchmark prevailing-party rates, offers versus awards, and award-to-QPA ratios by payor, service, geography, and IDRE
- Evaluates IDRE selection and determination patterns (fees, timeliness, and outcomes) and recommends selection and objection strategies
- Develops and refines offer and rate strategies for IDR and arbitration submissions, including recommended offer amounts by service, payor, and market
- Analyzes, tracks, and reports on payor contract performance; including yield per encounter, rate benchmarking (e.g., to Medicare, QPA, and commercial benchmarks), rate escalators, and underpayments
- Partners with AR Follow-Up and Revenue Cycle leaders to prioritize work queues, optimize open negotiation and IDR initiation timing, monitor payor compliance with payment of awards, and identify process improvements that increase yield
- Provides data analysis, underpayment and damages modeling, and exhibits in support of payor litigation and award enforcement, working closely with Legal and outside counsel
- Monitors and interprets regulatory, legal, and industry developments (e.g., CMS rulemaking, court decisions, state law changes, and payor behavior) and communicates the potential impact to business leaders
- Performs diligence revenue review of potential payor contracts and acquisitions, including out-of-network exposure and dispute history
- Designs and maintains dashboards, internal performance metrics, and ad-hoc analyses, and presents insights and recommendations to business leaders in clear, actionable terms
- Develops and implements analytics and data collection standards and processes to ensure the integrity of dispute, claims, and contract data
- Other duties as needed
Skills
- Working knowledge of the No Surprises Act, the federal IDR process, the qualifying payment amount (QPA), and state surprise billing and arbitration frameworks
- Demonstrated ability to analyze large public and proprietary data sets (such as the CMS IDR Public Use Files) and translate findings into clear strategy recommendations
- Strong understanding of payor contracting, fee schedules, claims adjudication, remittance and EOB data, and emergency medicine professional billing and coding
- Strong financial acumen and advanced analytical skills, including benchmarking, forecasting, and scenario and sensitivity modeling
- Advanced Excel, PowerPivot and a business intelligence tool (e.g., Power BI or Tableau)
- Strong business acumen and interpersonal skills
- Excellent oral and written communication and presentation skills, including the ability to explain complex data to executives, attorneys, and non-technical partners
- Sound judgment in handling confidential, privileged, and protected health information
- Independently driven, with the ability to manage complex projects and achieve department goals
- Superior time management, organizational, and problem-solving skills
- Bachelor's degree in Business, Finance/Accounting, Economics, Health Policy, Informatics, or a related field, or equivalent experience
- At least 5 years of reporting, analytics, and business operations experience
- At least 2 years of direct experience in payor contracting analytics, out-of-network reimbursement, or No Surprises Act IDR/state arbitration analytics
- At least 2-3 years of leadership experience
- Experience with SQL, Python, or R
- MBA or master's
- Preferably in the healthcare/provider space
- Experience with emergency medicine or other hospital-based physician groups, and experience supporting litigation or arbitration with Legal and outside counsel
Benefits
- Remote work
- Medical, dental, and vision insurance options
- Health savings accounts (HSA) and flexible spending accounts (FSA)
- 401(k) employee and employer contributions
- Paid time off, including vacation, sick leave, and company holidays
- Paid parental leave & family support benefits
- Short-term and long-term disability insurance
- Life and accidental death & dismemberment (AD&D) insurance
- Employee assistance programs & wellness resources
- Bonus eligibility, equity, or other incentive programs may be available depending on the role
Company Overview