Payer Strategy Analyst

Action Behavior Centers; United States; Remote; USD 85,000 - 120,000; Full time

Benefits offered by this job

PTO 10 days

10 paid holidays

2 flex days

Student loan repayment

Maternity/Paternity award up to $3,000

DoorDash Pass

Tuition discounts

401K with company matching

Job summary

ABC is seeking a Payer Strategy Analyst in Austin, TX to own end-to-end insurance contract life cycles, negotiate with commercial and Medicaid payers, and secure service authorizations. You will bridge payers with the Revenue Cycle Management team to ensure compliant onboarding for families.

Opportunity to drive enrollment workflows, maintain payer documentation, and collaborate across Credentialing, Contracting and Operations to improve enrollment efficiency and denial prevention.

Qualifications

• 3+ years in RCM-based roles.

Responsibilities

• Own end-to-end lifecycle of case-by-case insurance contracts.
• Analyze incoming out-of-network referrals and negotiate reimbursement rates.
• Coordinate enrollment, eligibility, and provider/payer enrollment submissions.
• Support payer plan discovery and maintain payer-specific requirements.
• Collaborate with Credentialing, Contracting, Revenue Cycle, Finance and Operations teams.

Skills

RCM

SCA/Network Gap Exception

Contracting

Billing/AR

ABA knowledge

Payer negotiations

Payers/insurance relationships

SalesForce/Zoho

Tools

Salesforce

Zoho

Job description

ABC Story:

Our story began in 2017 in Austin, TX. We started with humble roots but big aspirations. From 1 center in North Austin, our movement has inspired thousands of clinicians and operators. Today, the ABC community is 10,000+ strong, serving thousands of children with ASD. Growth with intentionality: We have an intentional focus on our core values. Each center is purpose-built, and each community of teammates is nurtured.

Position Summary:

The Payer Strategy Analyst owns the end-to-end lifecycle of case-by-case insurance contracts. In this role, you will analyze incoming out-of-network referrals, negotiate sustainable reimbursement rates directly with commercial and Medicaid payers, and secure the necessary service authorizations. You will serve as the bridge between payers and the RCM team to facilitate smooth, compliant onboarding for new and existing families.

Required Experience:

• 3 years+ experience in RCM-based roles
• Single Case Agreement / Network Gap Exception / Contracting - required
• Billing, AR - experience strongly preferred
• Understanding of ABA - experience preferred
• Experience in a billing company and/or large-scale healthcare organization - strongly preferred
• Deep understanding of out-of-network benefits, network adequacy laws, contract terms, and the behavioral health prior authorization lifecycle
• Proficiency or some experience with SalesForce, Zoho, or other project tracking systems

Knowledge, Skills and Abilities Required:

• Strong attention to detail and organizational skills
• Initiate Single Case Agreement (SCA) and Network Gap Exception processes in collaboration with internal ABC Teams (e.g. Authorization, Revenue Cycle, Ops, & Finance) and external Teams (e.g. Payers/Health Insurance Companies).
• Ability to advocate effectively and negotiate directly with Payers/major insurance carriers to secure acceptable reimbursement terms.
• Correspondence and communication with Payers/major insurance carriers, including relationship building across the SCA lifecycle.
• Exceptional verbal and written communication skills; ability to remain professional and empathetic when speaking with payers and families.
• Coordinate and submit provider and group enrollment applications for new and existing markets.
• Support new state and de novo market growth through responsibilities, including but not limited to: enrollment activities, ensuring accurate and timely setup with payers.
• Track enrollment application status, follow up on payer requests, and resolve enrollment-related issues.
• Review provider and group enrollment submissions for accuracy and completeness, identifying credentialing concerns and requesting appropriate follow-up information as needed.
• Complete EFT and ERA enrollments and communicate confirmation to collaborating internal teams.

Credentialing, Contracting & Payer Coordination:

• Work closely with the Credentialing Department to align enrollment and credentialing workflows.
• Partner with contracting specialists to support group updates, demographic changes, and payer-related maintenance.
• Act as a liaison between Credentialing and Revenue Cycle Management teams to support resolution of payer enrollment and setup issues.
• Communicate with payers to respond to information requests and ensure timely enrollment completion.

Market Support & Payer Documentation:

• Maintain accurate provider, group, and payer records across internal systems and databases.
• Organize and maintain payer documentation, including Single Case Agreements Agreements (SCAs), enrollment records, and related materials.
• Track renewal timelines, payer requirements, and compliance-related documentation for existing markets.

Process Support & Operational Effectiveness

• Establish, document, and follow enrollment processes and workflows appropriate to each payer and market.
• Support continuous improvement efforts by identifying enrollment inefficiencies or recurring payer issues.
• Assist with payer plan discovery and maintenance of payer-specific requirements, benefits, and market nuances as assigned.

Cross-Functional & Administrative Support

• Collaborate with internal teams including Credentialing, Contracting, Revenue Cycle, Finance, and Operations to support payer-related activities.
• Assign and coordinate tasks with outsourced or external partners as appropriate to support enrollment activities.
• Contribute to departmental projects and other related duties as assigned.
• 10 Days of PTO, 10 Paid Holidays, 2 Flex Days + More with Tenure
• Student Loan Repayment Employer Contributions
• Maternity/Paternity Award of up to $3,000 & FSA Options for Childcare
• Door Dash Pass and Regional Night of Honors
• Up to $600 Student Loan Repayment Options & Tuition Discounts

Additional Rewards:

• Professional development: we want to pour into you as you pour into ABC
• Leadership opportunities: To be the best, we have to continually keep learning and you get to push yourself here to learn more and take on more responsibilities, and show what you can do!
• 401K Retirement Plans with company matching

ABC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, age, religion, sex, sexual orientation, gender identity or expression, national origin, ancestry, disability, marital status, genetic information, veteran status, or any other status protected by applicable federal, state, or local laws, including the Pennsylvania Human Relations Act (PHRA). We are committed to creating an inclusive environment for all employees.

See what others have said when they made the decision to grow with us!

ABC offers evidence-based ABA therapy for children diagnosed with autism.

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