Payer Policy & Reimbursement Specialist

Springfield Clinic; Hawthorne Place (IL); On-site; USD 65,000 - 90,000; Full time

Job summary

Springfield Clinic is seeking a Payer Policy & Reimbursement Analyst to serve as the subject matter expert on payer medical, reimbursement, and administrative policies affecting physician practice revenue. You will research policies, assess financial impact, and provide actionable recommendations to operational and payer-facing stakeholders.

You will collaborate with Revenue Cycle, Coding, Clinical Operations, and Payer Relations teams to improve financial outcomes, identify trends in payer

Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, Public Health, or related field or equivalent experience.
• Minimum of 3 years of experience in healthcare reimbursement, revenue cycle, managed care, revenue integrity, payer relations, coding, or denial management.
• Working knowledge of CPT/HCPCS coding, ICD-10-CM, CMS reimbursement methodologies, commercial payer policies, and provider manuals.

Responsibilities

• Research and interpret payer medical, reimbursement, and administrative policies.
• Monitor payer policy changes and assess operational and financial impacts.
• Analyze payer requirements related to diagnosis, modifiers, frequency, site-of-service, and bundling.
• Compare payer policies against CMS, NCCI, CPT, and industry guidance.
• Serve as an internal resource for payer policy interpretation and reimbursement guidance.
• Identify trends in payer behavior and communicate findings to leadership and stakeholders.
• Collaborate with Revenue Cycle, Coding, Clinical Operations, and Finance to identify root causes and solutions.
• Prepare issue summaries including background, policy analysis, claim findings, financial impact, and action plans.
• Support payer meetings with policy research, documentation, and reimbursement analyses.

Skills

Healthcare reimbursement

Revenue cycle

Payer policy interpretation

Data analytics

Policy communication

Education

Bachelor's degree in Healthcare Administration or related field

Job description

Springfield Clinic is seeking a Payer Policy & Reimbursement Analyst to serve as the subject matter expert on payer medical, reimbursement, and administrative policies affecting physician practice revenue. You will research policies, assess financial impact, and provide actionable recommendations to operational and payer-facing stakeholders.

You will collaborate with Revenue Cycle, Coding, Clinical Operations, and Payer Relations teams to improve financial outcomes, identify trends in payer