Payer Strategy & Analytics Senior Finance Manager

US Acute Care Solutions; United States; Remote; USD 104,000 - 192,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

Health savings accounts (HSA) and flex

401(k) employer contributions

Job summary

US Acute Care Solutions is seeking a Senior Finance Manager for Payer Strategy & Analytics to lead analytics for payor contracting and out-of-network reimbursement. You will develop financial models, support IDR/arbitration, and partner with Finance, Accounting, Legal, and Revenue Cycle leadership to optimize reimbursement yield.

You will analyze CMS data, benchmark against Medicare/QPA, and design dashboards to track performance, cycles, and outcomes.

Qualifications

• 5+ years of reporting, analytics, and business operations experience, preferably in healthcare.
• Experience in payor contracting analytics, out-of-network reimbursement, or No Surprises Act IDR analytics.
• Strong Excel, Power BI/Tableau, SQL, Python, or R skills and ability to translate data for executives.

Responsibilities

• Analyze payor contracts and IDR/arbitration data to optimize reimbursement yield.
• Build financial models to support negotiations, renewals, and terminations.
• Develop dashboards and reports; communicate insights to leaders in clear terms.
• Monitor regulatory and industry developments and advise on impact.

Job description

Job Posting Closing Date: Open until FilledWhere do you belong?Your career is more than just a job, it's part of your life. Whether you’re a clinician, or non-clinical professional, at USACS you'll feel a sense of connection working with clinicians and office staff who share your interests and values. We want you to love coming to work each day because you believe in what you do and the people with whom you work. We care about your success.USACS also understands that location is important. We offer career opportunities for clinicians and non-clinical support staff from New York to Hawaii and numerous points in between. Our supportive culture, outstanding benefits and competitive compensation package is best in class.Job DescriptionGENERAL SUMMARY: The Payer Strategy & Analytics Senior Finance Manager is the organization’s analytical lead for payor contracting, out-of-network reimbursement, and the arbitration and litigation processes used to resolve payment disputes. The role provides financial tracking and data-driven decision support to scale out-of-network reimbursement through No Surprises Act (NSA) Independent Dispute Resolution (IDR), state arbitration, and litigation, and to optimize payor contract outcomes. Using CMS IDR Public Use Files and the group’s own arbitration data, the role provides decision support on IDR entity (IDRE) selection, offer and rate strategy, and AR follow-up to optimize reimbursement yield. As a reimbursement subject matter expert, the incumbent develops financial models and partners closely with Finance, Accounting, Legal, and Revenue Cycle leadership to ensure revenue projections and action plans are defensible and well understood.Location: RemoteESSENTIAL JOB FUNCTIONS:Serves as the key analytical partner to Payor Contracting, Revenue Cycle/AR Follow-Up, Legal, Finance, Accounting, and Operations on in-network and out-of-network reimbursement strategyBuilds financial models and recommendations to support payor contract negotiations, renewals, and terminations, including quantifying the impact of in-network versus out-of-network scenarios by payor and marketEnsures revenue recognition, budgets and forecasts are reflective of expected outcomes from IDR, arbitration, and litigation, in accordance with the Company’s revenue recognition policy.Owns the analytics supporting out-of-network reimbursement through the federal No Surprises Act IDR process and state arbitration programs; tracking volume, eligibility, filing deadlines, cycle time, win/loss rates, award amounts, and return on dispute costAnalyzes the CMS federal IDR Public Use Files and the group’s own IDR determination data to benchmark prevailing-party rates, offers versus awards, and award-to-QPA ratios by payor, service, geography, and IDREEvaluates IDRE selection and determination patterns (fees, timeliness, and outcomes) and recommends selection and objection strategiesDevelops and refines offer and rate strategies for IDR and arbitration submissions, including recommended offer amounts by service, payor, and marketAnalyzes, tracks, and reports on payor contract performance; including yield per encounter, rate benchmarking (e.g., to Medicare, QPA, and commercial benchmarks), rate escalators, and underpaymentsPartners with AR Follow-Up and Revenue Cycle leaders to prioritize work queues, optimize open negotiation and IDR initiation timing, monitor payor compliance with payment of awards, and identify process improvements that increase yieldProvides data analysis, underpayment and damages modeling, and exhibits in support of payor litigation and award enforcement, working closely with Legal and outside counselMonitors and interprets regulatory, legal, and industry developments (e.g., CMS rulemaking, court decisions, state law changes, and payor behavior) and communicates the potential impact to business leadersPerforms diligence revenue review of potential payor contracts and acquisitions, including out-of-network exposure and dispute historyDesigns and maintains dashboards, internal performance metrics, and ad-hoc analyses, and presents insights and recommendations to business leaders in clear, actionable termsDevelops and implements analytics and data collection standards and processes to ensure the integrity of dispute, claims, and contract dataOther duties as neededKNOWLEDGE, SKILLS AND ABILITIES:Working knowledge of the No Surprises Act, the federal IDR process, the qualifying payment amount (QPA), and state surprise billing and arbitration frameworksDemonstrated ability to analyze large public and proprietary data sets (such as the CMS IDR Public Use Files) and translate findings into clear strategy recommendationsStrong understanding of payor contracting, fee schedules, claims adjudication, remittance and EOB data, and emergency medicine professional billing and codingStrong financial acumen and advanced analytical skills, including benchmarking, forecasting, and scenario and sensitivity modelingAdvanced Excel, PowerPivot and a business intelligence tool (e.g., Power BI or Tableau); experience with SQL, Python, or R preferredStrong business acumen and interpersonal skillsExcellent oral and written communication and presentation skills, including the ability to explain complex data to executives, attorneys, and non-technical partnersSound judgment in handling confidential, privileged, and protected health informationIndependently driven, with the ability to manage complex projects and achieve department goalsSuperior time management, organizational, and problem-solving skillsEDUCATION AND EXPERIENCE:Bachelor’s degree in Business, Finance/Accounting, Economics, Health Policy, Informatics, or a related field, or equivalent experience (MBA or master’s preferred).At least 5 years of reporting, analytics, and business operations experience, preferably in the healthcare/provider space.At least 2 years of direct experience in payor contracting analytics, out-of-network reimbursement, or No Surprises Act IDR/state arbitration analytics.At least 2-3 years of leadership experience.Preferred: experience with emergency medicine or other hospital-based physician groups, and experience supporting litigation or arbitration with Legal and outside counsel.PHYSICAL DEMANDS:While performing the duties of this job, the employee is regularly required to sit for prolonged periods and occasionally walk, stand, bend, stoop, and lift up to 15 pounds.Required to have close visual acuity to perform the job.Salary Range: $103,887-$192,190Salary Range:$103,887.00 - $192,191.00Salary may be determined on several factors including but not limited to knowledge, skills, experience, education, geographical location and requirements stated in job description.USACS offers a comprehensive and competitive benefits package designed to support the health, well-being, and financial security of our employees.Benefits may vary based on role, location, and employment status, but generally include:Medical, dental, and vision insurance optionsHealth savings accounts (HSA) and flexible spending accounts (FSA)401(k) employee and employer contributionsPaid time off, including vacation, sick leave, and company holidaysPaid parental leave & family support benefitsShort-term and long-term disability insuranceLife and accidental death & dismemberment (AD&D) insuranceEmployee assistance programs & wellness resourcesAdditional compensation may include bonus eligibility, equity, or other incentive programs, depending on the role.Specific benefit offerings and eligibility will be provided during the hiring process and may be subject to change in accordance with applicable laws and company policies.Click the red apply button to submit an application and resume. If you are an USACS employee, please apply via the Jobs Hub in the Workday system.