Payor Analyst – Reimbursement HUB Services

🔥 1 hour ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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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, including referring healthcare professional files and insurance databases • Understand and update payer processing information, prior authorization and appeal requirements, contact information, forms, and payer best practices • Collect and validate new payer insights from cross-functional teams • Serve as a liaison across the hub, field reimbursement, market access, and analytics teams • Clean and update current system files • Receive payer notices and updates, load them into the payer database, and inform staff of payer changes • Notify relevant departments of payer changes and maintain records for future reference • Create payer roadmaps guiding users to billing, prior authorization, and appeal documentation and procedures • Assist the Quality team with documentation for audit and deep-dive requests, including internal, external, onsite, Medicaid, and PDE audits • Prepare progress presentations and present updates to clients during monthly or quarterly business reviews • Educate staff on departmental policies and procedures and help maximize first-submission success • Serve as a subject matter expert for operations and educate clients on best practices • Partner with client stakeholders to share intelligence on payer trends and changes • Participate in payer focus groups and other meetings to identify and share payer nuances and trends • Provide ongoing insights and key learnings to internal and client stakeholders • Work with leadership to communicate updates to hub stakeholders and with Quality to apply learnings 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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