Payer Contract and Reimbursement Analyst Full Time Days

Basic Purpose of the Job The Payer Contract and Reimbursement Analyst supports payer strategy, contract management, reimbursement analysis, and operational issue resolution across hospital, physician, ancillary, and specialty service lines. This role blends contract analytics, Epic contract management support, fee schedule maintenance, denial and underpayment analysis, and reporting functions to improve reimbursement accuracy, strengthen payer performance, and support organizational revenue goals. The position serves as a key liaison among payer relations, revenue cycle, business analytics, operational leaders, and managed care organizations. Requires a strong combination of analytical, communication, and leadership skills, along with a thorough understanding of healthcare operations and managed care principles from both the payer and provider perspectives. Job Requirements Minimum Education : Bachelor’s degree in business, finance, healthcare administration, or a related field preferred. Minimum Work Experience : Three years of healthcare, managed care, payer contracting, revenue cycle, healthcare analytics, or related experience required. Required Licenses/Certifications : Epic Resolute Hospital Billing and/or Professional Billing expected; Reimbursement Contract certification preferred or ability to obtain within a defined onboarding period. Required Skills, Knowledge, and Abilities : Strong knowledge of managed care contracting, payer reimbursement methodologies, and payer-provider operations; working knowledge of fee schedules and reimbursement terminology; ability to interpret contract language; experience with Epic contract management; advanced Excel skills; strong analytical, critical thinking, problem‑solving, communication skills; detail-oriented and able to manage multiple priorities. Physical Requirements Light lifting, pushing, and pulling for 10‑20 lbs.; occasional and frequent moving of objects under 10 lbs.; frequent sitting with some walking, standing, squatting, bending, and reaching; keyboard/computer/scanner/copier/printer use and repetitive motions may be required. Mental and Emotional Requirements Demonstrates independent discretion and sound decision‑making; manages stress appropriately; works effectively both independently and with others; maintains confidentiality and professionalism; handles multiple priorities effectively. Essential Functions Support negotiation of payer agreements across multiple service lines by providing analysis, modeling, and contract interpretation. Interpret payer contract terms, payment methodologies, and reimbursement logic, translating contract language into clear operational workflows. Build, configure, test, and maintain payer contract structures and expected reimbursement logic within Epic Contract Management or related systems. Maintain annual contract escalators and fee schedules for hospital, professional, and ancillary providers; update related analyses and share with internal partners. Perform contract modeling, reimbursement analysis, and payment variance reviews to identify financial risks, underpayments, missed revenue opportunities, and areas for revenue optimization. Analyze contract performance by comparing actual payments to expected reimbursement, and research and resolve payer denials, underpayments, bundling issues, and other payment discrepancies. Conduct ongoing payer monitoring, review newsletters and regulatory communications, and communicate operational impacts and required follow‑up to stakeholders. Partner with revenue cycle, business office, business analytics, credentialing, and operational leaders to resolve reimbursement and contract‑related issues and support joint operating committee activities. Provide consultative support to leadership and operational teams by delivering ad‑hoc analyses, insights on payer performance, denial trends, reimbursement changes, and financial improvement opportunities. #J-18808-Ljbffr 01 ETCH East Tennessee Children's Hospital Association, Inc.