Note: The job is a remote job and is open to candidates in USA. Metro Vein Centers is a growing healthcare practice specializing in state-of-the-art vein treatments. The Payor Relations Analyst will analyze provider reimbursement, contracts, fee schedules, and claims data to model financial impacts, identify underpayments, support negotiations, and improve reimbursement integrity. The role also manages payor relationships, reporting, dashboards, and cross-functional operational improvements.
Responsibilities
- Contract financial modeling – build multi-layered models forecasting the revenue impact of proposed rate adjustments, fee schedule changes, and alternative payment models (fee-for-service, capitation, value-based care, risk-sharing)
- Rate proposal analysis – evaluate proposed rates from payors using historical utilization and claims data to project net revenue impact by market, service line, and payor
- Reimbursement methodology analysis – analyze payor contracts, reimbursement methodologies, and financial performance across commercial, Medicare Advantage, and Managed Medicaid books of business
- Financial reporting & recommendations – interpret financial and reimbursement reports, build scenario and sensitivity analyses, and deliver actionable recommendations to leadership
- Contract yield auditing – track overall yield across commercial, Medicare Advantage, and Managed Medicaid plans to ensure payors reimburse according to executed agreements
- Underpayment & variance identification – isolate underpayments, payment variances, and contract non-compliance by analyzing claim outcomes against expected contractual terms, then quantify the exposure and drive recovery
- Fee schedule & system fee mapping – maintain and audit contract configuration, fee schedules, and reimbursement matrices in the EHR/practice management and RCM systems with rigorous accuracy and version control
- Renewal readiness – track contract expiration and escalator timelines so negotiation strategy begins well ahead of every deadline
- Negotiation modeling – partner with Payor Relations leadership to evaluate proposed reimbursement structures and build the financial case behind every ask
- Financial impact assessment – quantify the impact of new contracts, amendments, renewals, and reimbursement changes before and after execution
- Analytical support – support internal stakeholders throughout the contracting lifecycle, from initial modeling through post-signature validation
- Executive support – synthesize high-volume claims data, denial trends, and payment metrics into dashboards, briefing packets, and scenario analyses for the Senior Manager and Director, tracking payor mix, weighted-average rate increases, and contract timelines
- Present to leadership – explain complex financial findings to business leaders clearly and connect the numbers to the decision in front of them
- Data accuracy & integrity – own the accuracy of every analysis, including source data validation and reconciliation to system of record
- Day-to-day payor contact – serve as an operational point of contact for provider relations representatives across assigned health plans, resolving systemic claim issues and administrative friction
- Joint Operating Committees – prepare analytical agendas and performance data packets, and track actionable follow-ups for recurring JOC meetings with health plan representatives
- Denials root-cause & permanent fixes – partner with Patient Access, Billing, Coding, and Denial Management on root-cause analysis of recurring rejections, then establish process changes that prevent them from returning
- Payor policy & market awareness – monitor administrative updates, medical coverage policy changes, and pre-authorization requirements; communicate operational impact to RCM, Billing, and Clinical teams as we scale into new markets
- Collaborate with Finance, Credentialing, RCM, Billing, and Operations to translate financial data into strategic recommendations
- Identify opportunities to improve financial performance, reimbursement strategy, and operational efficiency across the organization
Skills
- Bachelor's degree in Finance, Accounting, Economics, Healthcare Administration, Business Analytics, Health Information Management, or a related field, or equivalent practical experience
- 3-5+ years of progressive healthcare financial analysis experience in provider reimbursement, payor relations, managed care, revenue cycle analysis, or healthcare financial/business analytics. Healthcare experience is required
- Strong finance or accounting foundation with demonstrated ability to interpret financial statements, reimbursement reports, and contract economics
- Demonstrated experience performing financial modeling, provider reimbursement analysis, and provider contract financial analysis
- Experience supporting contract negotiations through financial analysis and modeling
- Strong working knowledge of reimbursement methodologies (fee-for-service, capitation, value-based care), coding standards (CPT, ICD-10, HCPCS), and revenue cycle workflows
- In-depth understanding of commercial payor structures, Medicare Advantage, and Medicaid fee-for-service and managed care variations across states
- Advanced Excel (required) – complex data manipulation with dynamic functions, pivot tables, nested logic, financial modeling, forecasting, and scenario analysis
- EHR & payor platforms – experience with major EHR/billing software and health plan portals (Availity, CAQH)
- Presentation skills – able to explain financial data to business leaders in clear, decision-ready terms
- Analytical rigor – you reason from the data, pressure-test your own numbers, and can defend every figure you put in front of leadership
- Business acumen – you connect quantitative findings to real healthcare operations, clinical workflows, and revenue cycle impact
- Upward communication – you package complex datasets and contract terms into straightforward summaries for senior leadership
- Proactive problem-solving – a self-starter who finds root causes and drives resolution with internal teams and external payors alike
- Precision & ownership – accuracy is non-negotiable, and you juggle multiple projects and analysis at once
- Provider, MSO, or multi-state specialty group experience preferred; health plan, MCO, or payer-side reimbursement experience also considered
- Business intelligence & querying (preferred) – SQL, Power BI, or Tableau used to analyze healthcare claims and financial datasets and build dashboards. SQL is strongly preferred
- Experience in a rapidly growing MSO, specialty medical group, ASC, or multi-state provider environment
- Contract-modeling and analytics platforms such as Rivet; familiarity with multi-state credentialing and enrollment
- Knowledge of value-based care, risk arrangements, and payor quality programs
Benefits
- Medical, Dental, and Vision Insurance
- 401(k)
- Paid Time Off (PTO) + Paid Company Holidays
- Company-Paid Life Insurance
- Short-Term Disability Insurance
- Employee Assistance Program (EAP)
- Career Growth & Development Opportunities
Company Overview