Payor Reimbursement & Claims Optimization Analyst

optimadermatologycareers; Portsmouth (NH); Hybrid; USD 70,000 - 100,000; Full time

Job summary

Optima Dermatology seeks a Payor Reimbursement & Claims Remediation Analyst to join the Practice Support Center in Portsmouth, NH. The role focuses on analyzing payor payment performance, resolving systemic payor issues, and leading remediation efforts across billing and credentialing functions.

The analyst collaborates with Revenue Cycle leadership and cross-functional teams, producing data-driven insights to improve reimbursement accuracy and timeliness.

Qualifications

• Experience with payor reimbursement and claims remediation is preferred.

Responsibilities

• Run Power BI reports to analyze payor payment performance.
• Compare contracted fee schedules to actual payments to identify variances.
• Identify patterns of underpayments and policy-driven payment reductions.
• Quantify financial impact to prioritize remediation efforts.
• Create reporting packages and data files for remediation projects.
• Identify and manage systemic payor issues affecting claims adjudication and reimbursement.
• Lead remediation with payors to resolve underpayments and denials.
• Coordinate retrospective claims reprocessing and repayment.
• Track remediation efforts from identification through resolution.
• Serve as primary operational contact with payor claims, provider operations, contracting, and credentialing departments.
• Prepare and present payor issue summaries with data to leadership.
• Escalate complex issues with the Revenue Cycle Director as needed.
• Collaborate with billing, credentialing, compliance, contracting, and AR teams.
• Translate payor resolutions into forward-looking processing guidance.
• Provide data, reporting, and analysis to support decision making.
• Maintain documentation of remediation projects and status.

Skills

Data analysis

Cross-functional collaboration

Communication

Problem solving

Tools

Power BI

Job description

Optima Dermatology seeks a Payor Reimbursement & Claims Remediation Analyst to join the Practice Support Center in Portsmouth, NH. The role focuses on analyzing payor payment performance, resolving systemic payor issues, and leading remediation efforts across billing and credentialing functions.

The analyst collaborates with Revenue Cycle leadership and cross-functional teams, producing data-driven insights to improve reimbursement accuracy and timeliness.