Payer Analytics Manager

Koya is always looking for curious and passionate individuals who want to join a fast-paced team for a career in transforming venous and lymphatic care through innovative people-centric technologies that improve lives and empower self-care. Koya values integrity, humility, hard-work, camaraderie, and fun. We offer a base + bonus compensation package, and a competitive benefits program. Job Summary The Payer Analytics and Insights Manager is instrumental in analyzing payer data that supports shaping and refining strategies and tactics for market access, payer engagements, contract negotiations, and reimbursement. Leveraging both quantitative and qualitative insights, this role will proactively work with the market access and reimbursement operations leadership to drive informed decision-making, business processes, key performance indicators (KPIs), and uncover opportunities for growth and operational effectiveness. Primary responsibilities include: Analyze and maintain payer coverage policies and criteria to date Perform routine and ad hoc analyses of payer performance including outcomes from prior authorization, denials and appeals functions and identify trends Actively partner and participate in commercial analytics bringing a clear payer perspective into the overall commercial process and the full commercial picture (i.e. from sales order to collections outcomes) Partnering with cross-functional teams to ensure strategic alignment with organizational objectives Analyze workflows for manual processes for efficiency and possible automation. Success in this role requires a proficient understanding and experience with payer data including familiarity in aggregating and manipulating data associated with the market access and reimbursement processes, acquisition and analysis of payer data (i.e. prior authorizations, appeals, denials, claims), attention to detail, automation familiarity, advanced analytical capabilities and the ability to translate complex data both quantitative and qualitative into actionable insights for a range of stakeholders, including the market access and reimbursement teams and senior leadership. The successful candidate must understand the different types of payer environments including but not limited Medicare Fee for Service, Medicare Advantage, Commercial, Medicaid, and Managed Medicaid. This role reports to the Director, Reimbursement Operations. The role is full time, exempt and will work remotely. Essential Duties and Responsibilities The essential functions include, but are not limited to the following: Analyze and maintain payer coverage policies and criteria to date, Assess coverage policies and analyze the influence of utilization management on market access pull through Perform routine and ad hoc analyses of payer performance including outcomes from prior authorization, denials and appeals functions and identify trends Conduct in-depth analysis of payer contract performance and develop financial models to forecast revenue and support strategic pricing decisions during contract negotiations. Monitor and report key performance indicators (KPIs) such as team productivity, prior authorization and appeal outcomes, reimbursement rates, and days sales outstanding (DSO) using scorecards and dashboards. Evaluate authorization, appeal, and claims data to uncover performance trends, identify underpayments, and highlight opportunities for revenue optimization. Translate complex data insights into clear, actionable presentations for both technical and non-technical audiences, including senior leadership Translate manual workflows into RPA automations with reportable outcomes. Minimum Qualifications Education, Experience and Training Education: Bachelor's degree in a relevant field like Finance, Economics, Data Analytics, or Healthcare Administration Background in healthcare reimbursement or medical device industry preferred Proficient in advanced Excel functions and reporting tools, with expertise in Power Automate, Power BI, Tableau, or other business intelligence platforms. Knowledge, Skills and Abilities Analytical and technical skills: Strong abilities in financial modeling, data interpretation, trend analysis, and scenario modeling. Domain knowledge: A solid understanding of healthcare payer contracting, reimbursement methodologies, provider payment structures, and healthcare-related data. Communication skills: The ability to clearly explain complex financial and analytical concepts to both technical and non-technical audiences. Problem-solving: Demonstrate critical thinking and a proactive approach to identifying and troubleshooting issues. Collaboration: Proven ability to work effectively across multiple departments and build relationships with internal and external partners. Core Competencies Initiative & critical thinking Flexibility & adaptability Physical Functions and Work Environment The physical functions described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers; handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is usually low to moderate. Note This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any Koya manager authorized to provide instruction or assign work. Duties, responsibilities, and activities may change at any time with or without notice. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship. Koya Medical, Inc. is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

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The pay range for this role is: 125,000 - 130,000 USD per year (Remote (United States)) #J-18808-Ljbffr Koya Medical, Inc.