Reimbursement Specialist

Multi-site Dermatology Group Seeks Payor Reimbursement & Claims Remediation Analyst in Portsmouth, NH Optima Dermatology is recruiting a Payor Reimbursement & Claims Remediation Analyst to join our Practice Support Center, based in Portsmouth, NH. Location: Hybrid, 111 New Hampshire Ave. Portsmouth, NH 03801 Position Details The Payor Reimbursement & Claims Remediation Analyst analyzes payor payment performance and resolves systemic payor claims issues that affect reimbursement accuracy and timeliness. The role pairs hands‑on data analysis with operational payor remediation. The Analyst uses established Power BI reports to analyze payor adherence to contracted fee schedules, recognizes patterns of incorrect payment, and leads project‑level remediation efforts covering underpayments, incorrect claims adjudication, credentialing‑related issues, and payor policy misapplication. This position serves as the primary operational liaison between Optima Dermatology and payor claims, provider operations, contracting, and credentialing teams. The Analyst prepares the reporting and data files that drive payor remediation projects and works closely with Revenue Cycle leadership, FP&A, Accounts Receivable management, billing, and credentialing to recover underpayments, resolve payor issues, and implement forward‑looking process improvements. The role provides data and analysis to the Revenue Cycle Director to support decision making. This is an individual contributor role within RCM. Responsibilities Payor Fee Schedule Analysis & Payment Integrity Run established Power BI reports and use slicers, filters, and standard functions to extract the data needed to analyze payor payment performance. Analyze payor adherence to contracted fee schedules by comparing expected reimbursement against actual payment to identify variances. Recognize patterns of incorrect payment, including systematic underpayments, fee schedule load errors, bundling and downcoding trends, and policy‑driven payment reductions. Quantify the financial impact of identified payment issues to prioritize remediation by recovery value and operational urgency. Create reporting packages and data files that payors can use to open and process remediation projects, including impacted claim listings, expected versus paid detail, and supporting documentation. Payor Claims Remediation & Issue Resolution Identify and manage systemic, project‑level payor issues affecting claims adjudication, payment accuracy, and reimbursement timeliness. Lead remediation efforts with payors to resolve underpayments, recurring denials, credentialing‑related processing errors, and incorrect policy application. Coordinate retrospective claims reprocessing and repayment for impacted claims and accounts. Track remediation efforts from identification through resolution, ensuring accountability and follow‑through. Payor Engagement & Liaison Serve as the primary operational point of contact with payor claims, provider operations, contracting, and credentialing departments for systemic claims issues. Communicate directly with payor operational leaders to prioritize issues and drive resolution. Prepare and present payor issue summaries, root‑cause findings, and remediation requests, supported by clear data, in a professional manner. Escalate complex or stalled issues in partnership with the Revenue Cycle Director as appropriate. Cross‑Functional Collaboration Partner with cross‑functional leaders in billing and credentialing to remediate claims, contracting, adjudication, and credentialing issues with payors. Partner with FP&A to review and intake systemic payor issues identified through claims‑to‑contract and expected versus actual payment analysis. Receive escalated, project‑level payor issues from Accounts Receivable leadership related to adjudication errors, credentialing gaps, or payor policy interpretation. Collaborate with credentialing, billing, compliance, contracting, and AR teams to align remediation efforts and operational corrections. Translate payor resolutions into forward‑looking claims processing and billing guidance to prevent recurrence. Reporting & Analytics Support Provide data, reporting, and analysis to the Revenue Cycle Director to support decision making and departmental priorities. Support analysis activities across the revenue cycle, providing data and ad hoc reporting on request. Maintain clear documentation and visibility into active payor remediation projects, including scope, status, and financial impact. Communicate progress, risks, and outcomes to the Revenue Cycle Director and other key internal stakeholders. Support continuous improvement initiatives related to payor performance and claims accuracy. General and Administrative Maintain accurate documentation of payor communications, remediation activities, and outcomes. Respond promptly to emails, tasks, and requests related to payor projects. Maintain a strong working knowl #J-18808-Ljbffr