Payer Relations Analyst II - Manning - Finance

El Rio; Tucson (AZ); On-site; Full time

Job summary

Join a forward-thinking organization as a Payer Relations Analyst II, where you will leverage your financial analysis skills to enhance revenue cycle performance. This role involves collaborating with various departments to identify data anomalies, optimize workflows, and ensure clean claims submissions. You will play a crucial part in supporting the organization's financial health through data-driven insights and effective communication with both internal teams and external partners. If you're passionate about using data to drive improvements and enhance healthcare operations, this is an exciting opportunity to make a meaningful impact.

Benefits

Health Insurance

Retirement Plan

Paid Time Off

Training and Development

Flexible Scheduling

Qualifications

• Bachelor’s degree or 5 years of experience in a related field required.
• Two years of experience with healthcare data is essential.

Responsibilities

• Analyze financial data and trends related to revenue cycle management.
• Collaborate with IT to resolve claims formatting issues.

Skills

Financial Analysis

Data Visualization

Healthcare Data Analysis

Problem Solving

Communication Skills

Education

Bachelor’s Degree in Finance

Master’s Degree in Finance

Certification in Epic Contract Manager

Tools

EPIC Reporting Tools

Spreadsheets

Databases

Job description

Payer Relations Analyst II - Manning - Finance

Manning House I, Tucson, Arizona, United States of America

Job Description

Posted Saturday, April 5, 2025 at 9:00 AM

Shift: Monday - Friday

Pay Range: $30.50 - $44.17 Depending on Years of Experience

JOB PURPOSE: The Payer Relations Analyst II is responsible for performing financial analysis of varying complexities to include but not limited to revenue cycle system, modeling of contract performance to include value based and maintain fee schedules that drive expected allowable. This role works closely with the Business Office and its varied operations while supporting the Controller by compiling and analyzing Accounts receivable and Revenue trends. This position is instrumental in facilitating system and process fixes to ensure expedited submission of clean claims and improving revenue capture from data-driven points.

An employee in this position works with general supervision and reviews any work problems involving departures from standard policies, interpretations, or procedures that are presented to the supervisor for resolution.

Essential Job Functions:

• Proactively search for systems and data anomalies to identify issues and opportunities for manual and system corrections.
• Input and maintain contracts and benefit plans in the system.
• Test contracts and benefits plans to ensure output as expected. Create and maintain data for internal and external Revenue cycle analysis and modeling and explain and translate findings into general terms for non-technical audiences.
• Document business processes/procedures and make recommendations for workflow improvements and optimization.
• Serve as administrator for claims vendor and other related operational applications. Responsible for the ongoing maintenance, testing, development of workflows, workflow analysis, change documentation, application support, monitoring, and optimization of EPIC maintained systems.
• Participate in and/or lead the implementation or enhancements of systems, software, and solutions to system related problems, specific to Revenue Cycle.
• Evaluate Revenue Cycle needs and facilitate the development of configurations that support business processes.
• Promote and actively seek to develop positive internal (team members) and external (El Rio customers) relations. Collaborate across multiple organizational areas.
• Perform application validation as part of El Rio’s full Revenue Cycle testing policies. Identify and summarize basic characteristics in data and trends in data patterns related to Revenue Cycle, including, but not limited to, encounters, utilization, denials, payment by payer, and undistributed payments.
• Present information using data visualization techniques.
• Meet established time frames and rates of performance for the quality and quantity of work for the position.
• Analyze EDI and data requirements from customers and insurance carriers, to ensure clean claim submissions and work to resolve any barriers by working with IT PB EPIC partners to correct claims formatting issues.
• Act as a resource to support staff. Interact with all employee levels on billing/EDI issues.
• Work closely and cooperatively with IT development/support team on product design; make recommendations for changes to enhance support and usability.
• Gain and maintain a general understanding of applicable Federal, State, and commercial payer requirements, standards, regulations, or laws; as well as all organizational policies and procedures related to healthcare benefits payment and processing.
• Assist department leadership by performing and completing assigned processing that supports file maintenance within the Practice Management and Electronic Health Records systems.
• Identify processing anomalies observed and report these situations or observations to the assigned supervisor in a timely manner.
• Perform administrative or fiscal duties, tasks, and assignments supporting business office operations within established timeframes; meeting established rates of performance for the quality and quantity of work for the position; demonstrating a level of quality, efficiency, and accuracy in the employee’s job performance that ensures the highest standards of excellence.
• Assist with creating end-user training and documentation.
• Maintain at all times patient confidentiality by controlling the information being disclosed to authorized individuals ensuring compliance with all HIPAA and corporate compliance standards, as well as accepted confidentiality standards.
• Maintain a clean, safe, and hygienic work environment in compliance with all Policies and Procedures including but not limited to work areas, workstations, examination rooms, hand washing, infection prevention, and control etc. for this position.
• Demonstrate an understanding of and proficiency with the application of all compliance and reporting requirements respective to Joint Commission Certification (JCC) standards.
• Communicate effectively through written, verbal, and interpersonal skills as applied when interacting with employees, internal/external clients or representatives, or patients, successfully conveying and exchanging information in a positive and effective manner.

Minimum Education and Experience:

• Bachelor’s Degree in Finance, Data Analytics, or related field from an accredited college or university or 5 years work experience in a related field.
• Experience with Healthcare 5010 X12 healthcare transactions.
• Two (2) years experience working with healthcare data.
• Experience working with data using standard data tools including databases, spreadsheets, pivot tables, etc.
• Four (4) years’ experience working in a medical or dental analyst role in a healthcare environment.

If applicable, equivalent combination of education and experience may be considered, and must be directly related to the functions and responsibilities of the job.

Required Licenses, Certifications, and Registrations:

• Level I fingerprint clearance card: current valid and in good standing or have applied for it within seven working days after beginning employment.
• The Revenue Cycle or Analyst position requires Epic Contract Manager and Revenue Cycle Informatics certification. For candidates who meet minimum qualifications but are not yet Epic certified, the candidate has 90 days from the start date to obtain the required Epic certification. One probationary extension of 30 days may be granted with approval from Finance Management and Human Resources. Exceptions will be made to accommodate Epic training schedules, which may not always fall within the 90-day timeline. If the employee does not receive certification for the position within the defined timeframe, they are ineligible to remain in the position and may seek other opportunities within the Organization for which they are qualified or may resign.

Preferred Education, Experience, Skills, Abilities:

• Master’s Degree in a Finance or Data related field from an accredited college or university.
• Working experience with EPIC Reporting tools.
• Working experience with Electronic Health Record (EHR) systems, preferably Epic.
• Bilingual (English/Spanish) with the ability to speak, read and write in both languages.

Reasonable accommodations may be made to enable individuals with disabilities; known limitations related to pregnancy, childbirth, or related medical conditions; and for sincerely held religious beliefs, observances, and practices to perform the essential functions of the job.

El Rio Health does not discriminate based on race, color, religion, sex (including pregnancy, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, or other non-merit-based factors. It is our intention that all qualified applicants be given equal opportunity and that selection decisions are based on job-related factors.

El Rio Health requires all employees to have a Level One Fingerprint Clearance card. A.R.S. 36.425.03. If the prospective employee does not possess this prior to hire, fingerprint application must be completed within 7 days post hire. Level One (1) Non-IVP Fingerprint Clearance card must be received within 30 days after applying for the fingerprint card.

All employees are strongly recommended to obtain COVID-19 and maintain vaccination status (i.e., as recommended by CDC and/or other public health agencies) to include an Influenza vaccination. Personnel who decline to receive COVID-19 and/or flu vaccination per most recent CDC recommendations will be recommended to wear a facemask while in an El Rio Health facility, including both clinical and non-clinical areas from November 1 to April 30 (subject to change depending on viral activity). Subject to exemptions and accommodations when required by law.

All employees are required to undergo drug testing prior to employment and will be subject to post-accident, reasonable suspicion, return to duty, and follow-up drug and alcohol testing in compliance with Federal and State regulations for alcohol and controlled substance testing. Employees in positions holding responsibility for the safety and welfare of others will also be classified as safety sensitive.

El Rio Health is a non-profit 501(c)(3) Federally Qualified Health Center (FQHC) and abides by all applicable federal Drug-Free Workplace standards. El Rio Health is an equal opportunity employer.

Manning House I, Tucson, Arizona, United States of America