Remote Healthcare Payer & Reimbursement Analyst

Signature Performance; Boise (ID); Remote; USD 89,100 - 108,900; Full time

Benefits offered by this job

Health Insurance

Life Insurance

Short-term Disability

Long-term Disability

Paid Vacation

Paid Sick Leave

Paid Holidays

Tuition Assistance

401k Matching

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 PM guidance, analyzing data and translating policy updates into actionable business requirements for software configuration.

The role emphasizes deep knowledge of Medicare/VA/TRICARE policies, Excel modeling, and collaboration with Developers, QA and Client Services to ensure accurate pricing and reimbursement solutions.

Qualifications

• 3-4 years of professional experience in healthcare provider payment and reimbursement.
• Working knowledge of healthcare billing, compliance, and payer reimbursement regulations.
• Experience with professional and institutional payment fee schedules, including PPS (DRG, OPPS, Skilled Nursing, Home Health, Hospice, ASC).
• Knowledge of Critical Access, Sole Community, Behavioral Health, Inpatient/Outpatient Rehabilitation, LTC Hospital, and physician fee schedules.
• Ability to translate complex information into clear business requirements.
• Strong interpersonal and cross-functional collaboration skills.
• SQL reporting experience preferred.

Responsibilities

• Configure and maintain payment, pricing, and contract logic within reimbursement systems to ensure accurate claims adjudication.
• Analyze vendor bulletins, regulatory updates, and system changes for impact on processes, products and data systems.
• Review large healthcare data sets to identify trends and required changes.
• Interpret Medicare, VA, CHAMPVA, TRICARE policies and fee schedule data files.
• Collaborate with government agencies to clarify policies.
• Translate policy updates into actionable business requirements for software design and configuration.
• Develop complex Excel models to validate payment methodologies.
• Identify claim data characteristics for testing pricing logic.
• Partner with Developers, QA, Data, and Client Services to implement requirements on schedule.
• Create and execute test claims for development, UAT, QA, and configuration validation.
• Perform configuration testing and troubleshoot pricing or payment discrepancies.
• Maintain knowledge of company products, data, and services including contracting and reimbursement features.
• Independently evaluate and resolve pricing and reimbursement issues while managing multiple priorities.

Skills

Analytical skills

Attention to detail

Policy interpretation

Cross-functional collaboration

Prioritization

SQL reporting

Tools

Excel

TriZetto Facets NetworX

Optum Rate Manager

Web-based research tools

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 PM guidance, analyzing data and translating policy updates into actionable business requirements for software configuration.

The role emphasizes deep knowledge of Medicare/VA/TRICARE policies, Excel modeling, and collaboration with Developers, QA and Client Services to ensure accurate pricing and reimbursement solutions.