Head of Analytics (Remote)

We offer a base + bonus compensation package, and a competitive benefits program.

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.

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)

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.

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

Education, Experience and Training

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.

Strong abilities in financial modeling, data interpretation, trend analysis, and scenario modeling.

A solid understanding of healthcare payer contracting, reimbursement methodologies, provider payment structures, and healthcare-related data.

The ability to clearly explain complex financial and analytical concepts to both technical and non-technical audiences.

Reasonable accommodations may be made to enable individuals with disabilities to perform the functions.

All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. 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.

#LI-REMOTE

125,000 - 130,000 USD per year (Remote (United States))

#J-18808-Ljbffr Koya Medical, Inc.