Payer Contract & Revenue Cycle Analyst

Summit Health Management; Northern (KY); Hybrid; USD 64,000 - 80,000; Full time

Job summary

VillageMD is seeking a Revenue Cycle Payor Knowledge Analyst to support interpreting and analyzing payer contract terms and reimbursement methodologies. The role collaborates with Revenue Cycle Management, clinical leaders, and software teams to maximize reimbursements and ensure contract compliance.

This exempt position offers a salary range of $64,100 - $80,200 based on experience, with the company focusing on accessible, high-quality care.

Qualifications

• 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.

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 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 to ensure contract compliance and reimbursement integrity.
• Communicate identified opportunities and trends, 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.

Skills

Analytical skills

Revenue Cycle applications

Medical billing understanding

Communication skills

Computer systems adaptability

Tools

Rivet

Job description

VillageMD is seeking a Revenue Cycle Payor Knowledge Analyst to support interpreting and analyzing payer contract terms and reimbursement methodologies. The role collaborates with Revenue Cycle Management, clinical leaders, and software teams to maximize reimbursements and ensure contract compliance.

This exempt position offers a salary range of $64,100 - $80,200 based on experience, with the company focusing on accessible, high-quality care.