Strategic Payer Policy & Reimbursement Analyst

Springfield Clinic; Springfield (IL); On-site; USD 70,000 - 90,000; Full time

Job summary

Springfield Clinic seeks a Payer Policy & Reimbursement Analyst to serve as the subject matter expert for payer policies affecting physician practice revenue. You will research, interpret, and communicate reimbursement requirements to operational and payer-facing stakeholders, driving financial outcomes across Revenue Cycle, Coding, Clinical Operations, and Payer Relations teams.

The role emphasizes analyzing payer requirements, identifying trends, preparing issue summaries, and supporting

Qualifications

• Bachelor’s degree in Healthcare Administration, Business Administration, Finance, Public Health, or related field, or equivalent experience.
• Minimum of 3 years of experience in healthcare reimbursement, revenue cycle, managed care, or denial management.
• Working knowledge of CPT/HCPCS coding, ICD-10-CM, CMS reimbursement methodologies, and payer policies.

Responsibilities

• Research and interpret payer medical, reimbursement, and administrative policies.
• Monitor payer policy changes and assess operational and financial impacts.
• Analyze payer requirements related to diagnosis, modifiers, frequency limits, site-of-service, and edits.
• Prepare issue summaries with background, policy analysis, findings, financial impact, and action plans.
• Support payer meetings with policy research, documentation, and analyses.

Skills

Payer policy interpretation

Reimbursement analytics

Root cause analysis

Financial impact analysis

Data analytics

Critical thinking

Education

Bachelor's degree in healthcare

Tools

Reimbursement analytics tools

Job description

Springfield Clinic seeks a Payer Policy & Reimbursement Analyst to serve as the subject matter expert for payer policies affecting physician practice revenue. You will research, interpret, and communicate reimbursement requirements to operational and payer-facing stakeholders, driving financial outcomes across Revenue Cycle, Coding, Clinical Operations, and Payer Relations teams.

The role emphasizes analyzing payer requirements, identifying trends, preparing issue summaries, and supporting