Payer Analyst II

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $54.7k - $68.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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R1 RCM

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 2017

💼 Consulting

📦 Logistics

🏥 Healthcare

💰 Private Equity Round on 2024-07

Consulting • Logistics • Healthcare

R1 RCM is a leading provider of revenue cycle management solutions for the healthcare industry. With an emphasis on maximizing financial performance and optimizing patient care, R1 offers a comprehensive platform that integrates data analytics, intelligent technologies, and deep expertise in revenue cycle management. The company assists healthcare providers—ranging from hospitals and health systems to physician and specialty care practices—in capturing revenue opportunities, improving payer and patient cash flows, and ensuring compliance with government regulations. R1 is committed to driving cost reductions and revenue improvements while enhancing the patient experience. Their suite of services includes revenue recovery, clinical integrity, and regulatory navigation, making them a trusted partner for many top healthcare providers.

📋 Description

• Educate internal teams on payer guidelines • Lead payer and internal preparation calls • Conduct trend analyses of payer behavior and patterns • Mentor and guide junior analysts • Navigate and interpret payer guidelines and contracts • Research and compile documentation for outstanding AR resolution • Escalate claim issues with payers and stakeholders • Represent payer issues professionally to achieve optimal outcomes • Analyze data for payer trends and compliance • Follow guidelines for escalated claim submissions • Collaborate with leadership and teams to resolve and prevent escalations • Provide feedback to partners, clients, and departments • Identify root causes to improve AR collections and procedures • Manage complaints and solve moderately complex problems • Analyze payer responses to determine next steps • Diagnose and address root causes of escalations to enhance recoveries • Identify process improvement opportunities and communicate insights to leadership • Coordinate preparation calls with payers and internal teams • Lead payer-facing calls and communications as the R1 representative • Serve as a subject matter expert in managed care contracts and interpret complex payer contract language

🎯 Requirements

• High School Diploma • 5-7 years experience • No specific certification requirements • Proficient in basic mathematical operations • Proficient in English for reading, writing, and speaking • Ability to interpret business documents and interact professionally • Ability to define problems, collect data, and draw conclusions • Effective task management and teamwork • Strong communication, detail-oriented, and organized • High integrity and sound judgment • Ability to work in remote environments with minimal supervision • Analytical, problem-solving, and critical-thinking skills with attention to detail and quality • Proficiency in Healthcare Reimbursement Pricing Structure and Methodologies • Excellent working knowledge of Revenue Cycle operations, especially Inpatient and Outpatient Managed Care and Commercial Payers • Proficient in Microsoft Office Suite (Word, Excel, and Outlook) • Ability to implement process improvements based on leadership directives • Ability to multitask and manage demanding assignments • Ability to independently troubleshoot system challenges • Proficient written and verbal communication skills • Experience in facilitation and mentorship • Proficient computer skills

🏖️ Benefits

• Competitive benefits package • Opportunity to constantly learn, collaborate across groups, and explore new career paths • Meaningful work contributing to communities served around the world • Reasonable accommodations for disabilities