UBC

Payor Analyst – Pharma Reimbursement Hub

UBC

full-time

Posted on:

Location Type: Remote

Location: United States

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About the role

  • The Payor Analyst is responsible for maintaining critical system files, included but not limited to Insurance Databases Files and other applicable reference tools that support the reimbursement process.
  • Additionally, the Payor Analyst assists the audit team by pulling necessary documentation to support an audit, or deep dive requests as needed (i.e. internal, external, Onsite audits, Medicaid, PDE, etc.).
  • Maintain and manage the Payer Information Management System database, ensuring payer files are accurate, current, and aligned with reimbursement workflows.
  • This includes reviewing, cleaning, and updating insurance database records such as payer processing information, Prior Authorization and Appeals requirements, key contacts, required documentation, and documented payer best practices.
  • Serve as point person in collecting and validating new insights as they emerge from cross-functional team members on payer policies, requirements and review process nuances.
  • Act as a cross-functional liaison regularly connecting with other internal and external stakeholders to understand and disseminate knowledge changes in payer policies/requirements/processes.
  • Clean and update current system files.
  • Receive payer notices and updates through a variety of means, load to payer database and keep staff informed of payer changes.
  • Ensure that necessary departments are notified of changes, and maintain a file of payer changes or notices for future reference.
  • Work with appropriate operations groups to create payer roadmaps that help guide users to appropriate billing/PA/Appeal documentation and procedures based on the prescribed treatment.
  • Assist Quality team by retrieving and compiling required documentation for various audit requests and contributing to the development and delivery of client-facing updates, including monthly and quarterly business reviews.
  • Support staff training on departmental policies and procedures, with a focus on reinforcing best practices to maximize first-submission accuracy and effectiveness.
  • Serve as a SME for operations to help educate clients on best practices.
  • Collaborate with client stakeholders to receive and share insights on evolving payer trends and changes impacting access and reimbursement.
  • Participate in Payer Focus Groups or other applicable meetings to share and identify payer nuances or trends.
  • Share relevant insights and key learnings with internal and client stakeholders on an ongoing and as-needed basis.
  • Prepare updates in partnership with leadership and communicate key information to hub stakeholders.
  • Collaborate with the Quality team to ensure identified learnings are consistently incorporated into operational practice.

Requirements

  • 5+ years of professional work experience required.
  • Payer experience with a specific background in healthcare reimbursement, PBM, or hospital setting strongly preferred.
  • 3+ years of MS Office experience.
  • Background in Health Care or Reimbursement with 1-3 years auditing and quality assurance work experience preferred.
  • Knowledge of insurance plans including government payers, i.e. Medicaid, Medicare, and Tricare.
  • Ability to organize work assignments, set priorities and complete work with minimum supervision.
  • Knowledge and skills to understand insurance benefits including but not limited to the prior authorization and appeal process.
  • Experience in medical terminology- 1-3 years related Industry experience and/or training; or equivalent combination of education and experience.
  • Demonstrated leadership capabilities.
  • Demonstrated ability to handle multiple tasks simultaneously and to prioritize accordingly.
  • Proven ability to work with a high degree of accuracy and attention to detail.
  • Demonstrates core competencies of: attention to detail, organization skills, ability to prioritize and follow up, effective communication and ownership for one’s work.
  • Proficient in Excel, Access, Word and Power Point.
  • Strong written and verbal communication skills, including an ability to interact with internal/external business partners in person or by phone.
  • Able to work effectively with other internal/external functional departments.
Benefits
  • Remote opportunities
  • Competitive salaries
  • Growth opportunities for promotion
  • 401K with company match*
  • Tuition reimbursement
  • Flexible work environment
  • 20 days (about 3 weeks) of PTO
  • Paid Holidays
  • Employee assistance programs
  • Medical, Dental, and vision coverage
  • HSA/FSA
  • Telemedicine (Virtual doctor appointments)
  • Wellness program
  • Adoption assistance
  • Short term disability
  • Long term disability
  • Life insurance
  • Discount programs
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
auditingquality assuranceinsurance database managementpayer processing informationprior authorizationappeals processmedical terminologydata cleaningdata validationreimbursement workflows
Soft Skills
attention to detailorganizational skillsability to prioritizeeffective communicationleadership capabilitiesability to handle multiple tasksownership of workcollaborationtraining and supportinsight sharing