Payor Analyst – Reimbursement HUB Services

🔥 31 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 10%

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UBC

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

🏥 Healthcare

💼 Consulting

🧬 Biotechnology

Healthcare • Consulting • Biotechnology

UBC is a company dedicated to improving patient outcomes by connecting specialty therapies to patients in need. They provide modern and customized solutions focusing on access, safety, and evidence generation for biopharmaceutical products. UBC specializes in evidence development, risk management, and patient access, utilizing real-world data and innovative technologies to optimize the healthcare journey and ensure effective medication use.

📋 Description

• Maintain the Payer Information Management System database files • Maintain Referring Healthcare Professional Files and Insurance Database files, including payer processing information, prior authorization and appeal requirements, contact information, forms, and payer best practices • Collect and validate new insights from cross-functional team members • Serve as a cross-functional liaison to understand and disseminate changes in payer policies, requirements, and processes • Clean and update current system files • Receive payer notices and updates, load them to the payer database as appropriate, and keep staff informed • Notify necessary departments of payer changes and maintain a reference file of payer notices • Work with operations groups to create payer roadmaps guiding users to billing, prior authorization, appeal documentation, and procedures • Assist the Quality team with documentation for audits and deep-dive requests • Prepare progress presentations and present to clients in monthly or quarterly business reviews • Educate staff on departmental policies and procedures, including maximizing first-submission success • Serve as a subject-matter expert for operations and educate clients on best practices • Partner with client stakeholders on payer trends and changes • Participate in payer focus groups and related meetings • Provide ongoing insights and key learnings to internal and client stakeholders • Work with leadership to communicate updates to hub stakeholders • Work with Quality to ensure learnings are implemented in practice

🎯 Requirements

• 5+ years of professional work experience required • Payer experience with a specific background in healthcare reimbursement, PBM, or hospital setting strongly preferred • 3+ years of MS Office experience • Background in Health Care or Reimbursement with 1-3 years auditing and quality assurance work experience preferred • Knowledge of insurance plans including government payers, i.e. Medicaid, Medicare, and Tricare • Knowledge and skills to understand insurance benefits including but not limited to the prior authorization and appeal process • Experience in medical terminology • 1-3 years related Industry experience and/or training; or equivalent combination of education and experience • Demonstrated leadership capabilities • Demonstrated ability to handle multiple tasks simultaneously and to prioritize accordingly • Proven ability to work with a high degree of accuracy and attention to detail • Attention to detail, organization skills, ability to prioritize and follow up, effective communication and ownership for one’s work • Proficient in Excel, Access, Word and Power Point • Strong written and verbal communication skills, including an ability to interact with internal/external business partners in person or by phone • Able to work effectively with other internal/external functional departments • High School Diploma or GED required • Must be able to work M-F, 8:00 AM-4:30 PM ET

🏖️ Benefits

• Remote opportunities • Competitive salaries • Growth opportunities for promotion • 401K with company match* • Tuition reimbursement • Flexible work environment • Discretionary PTO (Paid Time Off) • Paid Holidays • Employee assistance programs • Medical, Dental, and vision coverage • HSA/FSA • Telemedicine (Virtual doctor appointments) • Wellness program • Adoption assistance • Short term disability • Long term disability • Life insurance • Discount programs

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