Analyst, Revenue Cycle Payor Knowledge

shm; United States; On-site; USD 70,000 - 110,000; Full time

Job summary

SHM is seeking a Revenue Cycle Payor Knowledge Analyst to interpret payer terms, maintain fee schedules, and identify discrepancies between contracts and reimbursements. You will analyze data, support payer negotiations, and collaborate with Revenue Cycle Management, clinical leaders, and IT teams.

Responsibilities include managing the Rivet contract tool, updating the Payer Contract Matrix, preparing client-facing reports, and communicating opportunities with data support to help maximize

Qualifications

• Strong analytical ability to reconstruct multi-step processes and identify errors.
• Extensive knowledge of Revenue Cycle applications, updates, and enhancements.
• Basic understanding of medical billing, including charge entry, EOB/remittance, payment posting, and reconciliation.

Responsibilities

• Manage the contract management tool, Rivet.
• Oversee SHM Revenue Cycle fee-related tablespaces.
• Prepare and attend payer meetings.
• Create, maintain, and validate fee schedules based on contract payments.

Skills

Analytical skills

Revenue Cycle knowledge

Communication skills

Technical proficiency

Education

Healthcare certifications (e.g., CSPR, CRCR, CHAM, CHFP, FHFMA, FACHE)

Tools

Rivet

Payer contract systems

Job description

About Our Company

We're a physician-led, patient-centric network committed to simplifying health care and bringing a more connected kind of care.

Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and virtually through VillageMD and our operating companies Village Medical , Village Medical at Home , Summit Health , CityMD , and Starling Physicians.

When you join our team, you become part of a compassionate community of people who work hard every day to make health care better for all. We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure all patients have access to high-quality, connected care services that provide better outcomes at a reduced total cost of care.

Please Note: We will only contact candidates regarding your applications from one of the following domains: @summithealth.com, @citymd.net, @villagemd.com, @villagemedical.com, @westmedgroup.com, @starlingphysicians.com, or @bmctotalcare.com.

Job Description

The Revenue Cycle Payor Knowledge Analyst will support the Revenue Cycle Payor Knowledge Team by interpreting and analyzing payer contract terms and reimbursement methodologies. The role includes reviewing payer contract language to create and maintain accurate fee schedules, identifying discrepancies between contracted terms and actual reimbursements, and analyzing data to identify opportunities to maximize reimbursements through payer negotiations, projects, and trends impacting the organization's revenue. This position will collaborate closely with various internal teams, including Revenue Cycle Management, clinical leaders, application vendors, and SHM Revenue Cycle Systems and L&D teams.

Key Responsibilities

• Manage the contract management tool, Rivet.


• Oversee SHM Revenue Cycle fee-related tablespaces.


• Support prioritization and implementation of system changes and updates.


• Troubleshoot issues and inquiries from end users.


• Coordinate and participate in project task deliverables.


• Prepare and attend payer meetings.


• Review, interpret, extract, and organize key information from payer contracts and amendments into the Payer Contract Matrix.


• Create, maintain, and validate fee schedules based on contract payment sources and reimbursement rates.


• Analyze reimbursement data to identify discrepancies, payer trends, and opportunities for maximizing reimbursement.


• Research payer contract documentation and payer websites (e.g., provider manuals, billing policies) to ensure contract compliance and reimbursement integrity.


• Communicate identified opportunities and trends, both internally and externally, with data support.


• Compile reports for RCM team members to review unfavorable claim outcomes, pursue recovery of underpayments, or submit corrected claims.


• Initiate contact with payers to validate contracted rate discrepancies.


• Collaborate with the Payor Knowledge team to resolve fee schedule errors, load new codes, and map payers.


• Work with product and technology teams to develop new technology solutions or enhance existing software.


• Prepare client-facing reports and special projects related to contracts and fee schedules, adhering to company branding and templates. Reports may include Charge Master Analysis, Quarterly Payer Scorecard Reports, Claim Analysis Reports, and Underbilling Alerts.

Minimum Knowledge, Skills, and Abilities

• Strong analytical skills to reconstruct multi-step processes and correct sources of error.


• Extensive knowledge of Revenue Cycle applications, including updates and enhancements.


• Basic understanding of medical billing, including charge entry, EOB/remittance review, payment posting, and reconciliation practices.


• Excellent verbal and interpersonal communication skills, with the ability to explain problems, solutions, and changes effectively.


• Proficiency with computer systems and the ability to quickly adapt to new programs and websites.

Preferred Knowledge, Skills, and Abilities

• Ability to interpret contract language and manage contract database updates.


• Advanced analytical and research skills with strong attention to detail and the ability to manage multiple complex contracts simultaneously.


• Industry certifications (e.g., CSPR, CRCR, CHAM, CHFP, FHFMA, FACHE) are a plus.


• Knowledge and experience with various practice billing software systems, including understanding the workflow, processes, and billing procedures.


• Familiarity with clinic, provider groups, and hospital revenue cycle and insurance payment methodologies.


• Expertise in payer contracts, insurance types, and related billing and reimbursement policies.


• Strong communication, problem-solving, and organizational skills.


• Ability to manage payer contract, fee schedule, and analysis responsibilities across multiple business units.


• Initiative to stay current with evolving billing practices and share knowledge with the team.


• Knowledge of state, federal, and commercial payer r