Revenue Cycle Payor Insights Analyst

Summit Health Management; Trenton (NJ); On-site; USD 64,000 - 80,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

401k plan

FSA

Job summary

VillageMD is seeking a Revenue Cycle Payor Knowledge Analyst to interpret payer contract terms, analyze reimbursements, and maintain fee schedules. You will collaborate with Revenue Cycle Management, clinical leaders, and IT teams to drive accurate billing and maximize revenue.

The role emphasizes data-driven decision making, contract interpretation, and cross-functional coordination to improve payer performance and compliance across multiple business units.

Qualifications

• Strong analytical skills to reconstruct multi-step processes and correct sources of error.
• Extensive knowledge of Revenue Cycle applications, including updates and enhancements.
• Basic understanding of medical billing, including charge entry, EOB/remittance review, payment posting, and reconciliation practices.
• Excellent verbal and interpersonal communication skills, with the ability to explain problems, solutions, and changes effectively.

Responsibilities

• Manage the contract management tool, Rivet.
• Oversee SHM Revenue Cycle fee-related tablespaces.
• Support prioritization and implementation of system changes and updates.
• Troubleshoot issues and inquiries from end users.
• Coordinate and participate in project task deliverables.
• Prepare and attend payer meetings.
• Review, interpret, extract, and organize key information from payer contracts and amendments into the Payer Contract Matrix.
• Create, maintain, and validate fee schedules based on contract payment sources and reimbursement rates.
• Analyze reimbursement data to identify discrepancies, payer trends, and opportunities for maximizing reimbursement.
• Research payer contract documentation and payer websites to ensure contract compliance and reimbursement integrity.
• Communicate identified opportunities and trends, both internally and externally, with data support.
• Compile reports for RCM team members to review unfavorable claim outcomes, pursue recovery of underpayments, or submit corrected claims.
• Initiate contact with payers to validate contracted rate discrepancies.
• Collaborate with the Payor Knowledge team to resolve fee schedule errors, load new codes, and map payers.
• Work with product and technology teams to develop new technology solutions or enhance existing software.
• Prepare client-facing reports and special projects related to contracts and fee schedules, adhering to company branding and templates.
• Reports may include Charge Master Analysis, Quarterly Payer Scorecard Reports, Claim Analysis Reports, and Underbilling Alerts.

Skills

Analytical skills

Revenue Cycle applications

Medical billing knowledge

Verbal communication

Technical proficiency

Tools

Rivet

Job description

VillageMD is seeking a Revenue Cycle Payor Knowledge Analyst to interpret payer contract terms, analyze reimbursements, and maintain fee schedules. You will collaborate with Revenue Cycle Management, clinical leaders, and IT teams to drive accurate billing and maximize revenue.

The role emphasizes data-driven decision making, contract interpretation, and cross-functional coordination to improve payer performance and compliance across multiple business units.