Payor Reimbursement & Claims Remediation Analyst

Optima Dermatology; Portsmouth (NH); On-site; USD 90,000 - 120,000; Full time

Job summary

Optima Dermatology in Portsmouth, NH seeks a Payor Reimbursement & Claims Remediation Analyst to join the Practice Support Center. This individual contributor role focuses on analyzing payor payment performance and driving remediation for underpayments and misapplied policies.

The analyst collaborates with Revenue Cycle leadership, billing, credentialing, and contracts teams to recover underpayments and implement process improvements. HIPAA compliance is required.

Qualifications

• Minimum of 5 years in Revenue Cycle Management, payor operations, claims analysis, or related roles.
• Experience analyzing reimbursement and payment data, including expected vs actual payment and fee schedule variance.
• Proficient in Power BI for reporting and data extraction.

Responsibilities

• Run Power BI reports to analyze payor payment performance and variances.
• Lead remediation with payors to resolve underpayments and denials.
• Coordinate retrospective claims reprocessing and repayment for impacted claims.
• Prepare payor issue summaries and root-cause analyses for leadership.

Skills

Power BI

Data analysis

Revenue Cycle Management

Communication

Education

Bachelor's degree in healthcare administration, business, finance, data analytics, or a related field

High school diploma or equivalent

Tools

Power BI

Job description

Optima Dermatology in Portsmouth, NH seeks a Payor Reimbursement & Claims Remediation Analyst to join the Practice Support Center. This individual contributor role focuses on analyzing payor payment performance and driving remediation for underpayments and misapplied policies.

The analyst collaborates with Revenue Cycle leadership, billing, credentialing, and contracts teams to recover underpayments and implement process improvements. HIPAA compliance is required.