Payer Analyst

The Payer Analyst is responsible for monitoring, analyzing, and evaluating payer behaviors, market access trends, policy changes and delivering comprehensive reimbursement assessments on payer attributes to leadership. This role focuses on evaluating payer trends to inform necessary changes in payer requirements, propose the need to submit policy reconsiderations or internal payer policy changes to drive improvements.

In this position, the Payer Analyst will serve as a subject matter expert on payer policies and conducts routine data analysis of payer attributes and reimbursement across all payers contributing to the success of the organization and enhancing patient access to our products.

• Monitor weekly reports to analyze payer outcomes, and propose plans to address adverse results
• Support targeted strategies for specific payers, including appeals, that frequently deny company products
• Stay informed about changes in payer policies, regulations, and industry trends that may impact reimbursement processes
• Analyze data and identify trends, opportunities for improvement, and areas of concern
• Assess payer decisions to determine root causes and develop propose to leadership plans for prevention
• Collaborate with cross-functional teams to ensure alignment on payer requirements, supporting paperwork and documentation processes.
• Prepare and present regular reports to management on payer performance.
• Serve as a liaison with assigned payers to address broader issues related to medical necessity and denials
• Develop key internal partnerships to support the analysis of payer attributes
• Provide guidance on payer-related matters to various departments within the organization and assist and educate internal teams in understanding payer policy and requirements

Other Related Responsibilities

• Maintain compliance with all appropriate regulatory requirements including HIPAA
• Respond to requests for data as needed
• Engage in cross-functional collaboration with RCM (POMs, sales, Ops, etc.)
• Other duties as assigned

Education & Experience
Required:

• Bachelor's Degree or at least 7 years of equivalent work experience
• 3+ years of experience in market access, payer relations, medical device, reimbursement, healthcare administration, regulatory or related field
• Previous experience analyzing data and trends

Preferred:

• Previous experience working as an analyst or performing analytics used in business decision making
• Previous experience with payer regulations and processes
• Reimbursement, payer relations, or previous market access experience

Knowledge & Skills

• Excellent analytical skills with ability to navigate ambiguity and simplify communication of complex scenarios
• Strong proficiency with Microsoft Office, Teams, and Outlook, PowerPoint and Excel
• Strong understanding of health insurance methodologies (coding, coverage, prior authorizations, clinical criteria, billing, payments)
• Knowledge of medical terminology
• In-depth knowledge of healthcare billing and reimbursement processes
• Familiarity with healthcare regulations and compliance requirements
• Proficiency in data analysis and report generation
• Ability to take initiative and drive projects with minimal supervision
• Able to communicate comfortably and effectively both verbally and in writing with payer clinical review staff and/or medical directors
• Strong critical thinking ability with a bias towards action/execution
• Excellent attention to detail and strong problem-solving skills
• Ability to proactively identify issues and recommend or collaborate on solutions