Payer Payment & Reimbursement Analyst

Signature Performance, Inc.; Northern (KY); Hybrid; USD 89,100 - 108,900; Full time

Benefits offered by this job

Health Insurance

Life Insurance

Paid Vacation

401(k) Program

Job summary

Signature Performance is seeking a Payer Payment and Reimbursement Analyst to improve healthcare reimbursement methodologies. This role involves working closely with team members and government agencies to ensure accurate claims adjudication.

The ideal candidate will have strong analytical skills and the ability to manage multiple projects. They will interpret healthcare policies and develop complex Excel models to support reimbursement processes.

Qualifications

• Experience analyzing healthcare payment and reimbursement.
• Expertise in healthcare billing and payer reimbursement regulations.
• Knowledge of various payment fee schedules.

Responsibilities

• Manage healthcare payment and reimbursement methodologies.
• Ensure accurate claims adjudication in reimbursement systems.
• Collaborate with government agencies on policies.
• Perform testing of claims and configurations.

Skills

Analytical skills

Attention to detail

Problem-solving

Communication

Team collaboration

Education

3-4 years in healthcare payment

Tools

Microsoft Office

SQL

TriZetto Facets NetworX

Optum Rate Manager

Job description

The Payer Payment and Reimbursement Analyst will work with the team members in healthcare payment & reimbursement methodologies, laws and regulations under the mentorship and guidance of the Project Manager.

• Tell us about your experience with Payment and Reimbursement Methodologies.
• Are you a team player and a self-motivator?
• What is your experience with conducting business in a way that is credit to a company?
• We are counting on you to manage multiple projects using your problem-solving skills.
• We are looking for someone UNCOMMON. What is uncommon about you?

Are you highly committed? Are you team-oriented? Do you value professionalism, trust, honesty, and integrity? If so, we cannot wait to meet you.

About the Position

• Configure and maintain payment, pricing, and contract logic within healthcare reimbursement systems to ensure accurate claims adjudication.
• Analyze vendor bulletins, regulatory updates, and system changes to assess impact on internal processes, products, and data systems.
• Review and evaluate large healthcare data sets to identify trends, anomalies, and required system or process changes.
• Interpret Medicare, VA, CHAMPVA, and TRICARE policies, including rulings, transmittals, bulletins, manuals, and physician fee schedule data files.
• Collaborate directly with government agencies to clarify new or existing reimbursement and payment policies.
• Translate reimbursement policy updates and payment methodology changes into clear, actionable business requirements for software design and system configuration.
• Develop complex Excel models and formulas to validate, explain, and support payment methodologies.
• Identify claim data characteristics required for testing pricing logic and configuration accuracy.
• Partner with Developers, QA, Data, and Client Services teams to ensure requirements are implemented accurately and on schedule.
• Create and execute test claims for development, UAT, QA, and configuration validation.
• Perform configuration testing and troubleshoot pricing or payment discrepancies.
• Maintain deep knowledge of company products, data, and services, including commercial contracting and reimbursement features.
• Independently evaluate and resolve complex pricing and reimbursement issues while managing multiple priorities.

Core Competencies

• Strong analytical and critical-thinking skills
• High attention to detail and quality
• Ability to synthesize complex policy and data into practical solutions
• Effective collaboration and communication
• Self-directed with strong prioritization skills
• 3-4 years of professional experience in healthcare provider payment and reimbursement.
• Working knowledge of healthcare billing, compliance, and payer reimbursement regulations.
• Experience with professional and institutional payment fee schedules, including but not limited to:
  • Experience with Prospective Payment Systems (PPS), including:
    • DRG, OPPS, Skilled Nursing, Home Health, Hospice, and ASC
• Knowledge of:
  • Critical Access, Sole Community
  • Behavioral Health
  • Inpatient Rehabilitation/Outpatient Rehabilitation
  • Long Term Care Hospital
  • Federally Qualified Health Center
  • Physician Fee Schedule, DME/DEMPOS, Ambulance, AWP, Lab, ESRD, Hospice, Home Health, Anesthesia, ADA
  • Integrated Outpatient Code Editor (I/OCE)
• Ability to collect, research, interpret, and document complex information into clear and concise business requirements.
• Strong interpersonal and cross-functional collaboration skills.
• Working knowledge of provider types, specialties, and their applicable reimbursement methodologies.
• Ability to communicate effectively with diverse internal and external stakeholders.
• SQL reporting experience preferred.

Preferred Requirements

• Proficiency in Microsoft Office applications (Teams, Word, Excel, PowerPoint, Visio, Access).
• Experience using web-based research tools and regulatory resources.
• Knowledge of claims adjudication and payment workflows.
• Experience configuring TriZetto Facets NetworX.
• Experience configuring Optum Rate Manager.

About Us

You are uncommon. We are, too. We are looking for people to help us in our mission of working hard at lowering healthcare administrative costs for federal government agencies, payers, and providers. At Signature, our mission is to improve the health of our clients' business and make the lives of the people we work with better. As we continue to experience exponential growth, we are looking for uncommon individuals to enhance our vision. We will continue to accomplish our mission by leading with our values of Passion, Courage, Integrity, and Respect in all interactions, making us a consistent annual Best Places to Work organization. We need uncommon leaders with uncommon qualities to shape our uncommon culture and achieve our uncommon mission.

About the Benefits

When you are a member of Signature Performance, you are a part of a solutions-based organization where the values of passion, integrity, courage, and respect are the driving forces behind all our decision-making. We trust you to do important work and bring the best version of yourself to work every day, so we want to help you achieve a work-life balance while consistently challenging yourself. Signature believes in fully developing each one of our Associates. Our performance-driven philosophy boasts competitive pay and additional position specific incentives, where world-class training and development, resources, and events drive our award-winning culture where everyone thrives.

• Health Insurance
• Fully Paid Life Insurance
• Fully Paid Short- & Long-Term Disability
• Paid Vacation
• Paid Holidays
• Professional Development and Tuition Assistance Program
• 401(k) Program with Employer Match

Security Requirements

• U.S. Citizenship or naturalized citizenship is required for this position.
• All work on all positions at Signature Performance must be completed in the continental United States, Alaska, or Hawaii.

Work Schedule

TBD

Compensation Range

$99,000/Annually

Position Type

Full Time

Employer Privacy Policy

This Company is an Equal Opportunity Employer, and does not discriminate on the basis of race, gender, ethnicity, religion, national origin, age, disability, veteran status, or on any other basis prohibited by law. Information on race, gender and national origin will only be used for statistical and recordkeeping purposes, and will not be used in making any employment decisions. All information provided will be kept separate from your expression of interest. Providing this information is strictly voluntary, and you will not be subjected to any adverse action or treatment if you choose not to provide this information. If you do not choose to answer these questions, we ask that you select "Decline to Identify" for each question. Thank you for your voluntary cooperation.