Remote Healthcare Payer Analytics & Reimbursement Analyst

Signature Performance; Newark (NJ); Remote; USD 89,100 - 108,900; Full time

Benefits offered by this job

Health Insurance

Fully Paid Life Insurance

Fully Paid Short- & Long-Term Disabl

Paid Vacation

Paid Sick Leave

Paid Holidays

Professional Development and Tuition

401(k) Program with Employer Match

Job summary

Signature Performance is seeking a Payer Payment and Reimbursement Analyst for a remote, nationwide role. You will work on healthcare payment methodologies under the guidance of a Project Manager, analyzing data and regulatory updates to ensure accurate claims adjudication.

You will translate reimbursement policy changes into actionable business requirements for software design, build complex Excel models, and collaborate with Developers, QA, Data, and Client Services to implement and validate

Qualifications

• 3-4 years of healthcare provider payment and reimbursement experience.
• Working knowledge of healthcare billing, compliance, and payer reimbursement regulations.
• Experience with professional and institutional payment fee schedules and PPS (DRG, OPPS, SNF, Home Health, Hospice, ASC).
• Knowledge of multiple provider types and their reimbursement methodologies.
• SQL reporting experience preferred.

Responsibilities

• Configure and maintain payment, pricing, and contract logic within reimbursement systems.
• Analyze regulatory updates and system changes for impact on processes and data systems.
• Review large healthcare data sets to identify trends and required changes.
• Interpret Medicare, VA, CHAMPVA, and TRICARE policies and schedules.
• Collaborate with government agencies to clarify policies.
• Translate policy updates into clear business requirements for software design.
• Develop complex Excel models to validate payment methodologies.
• Create and execute test claims for development, UAT, QA, and configuration validation.
• Partner with Developers, QA, Data, and Client Services to ensure timely implementation.
• Maintain knowledge of products and reimbursement features.

Skills

Analytical skills

Attention to detail

Policy interpretation

Cross-functional collaboration

SQL knowledge

Communication

Tools

Excel

TriZetto Facets NetworX

Optum Rate Manager

Job description

Signature Performance is seeking a Payer Payment and Reimbursement Analyst for a remote, nationwide role. You will work on healthcare payment methodologies under the guidance of a Project Manager, analyzing data and regulatory updates to ensure accurate claims adjudication.

You will translate reimbursement policy changes into actionable business requirements for software design, build complex Excel models, and collaborate with Developers, QA, Data, and Client Services to implement and validate