The Payer Analytics Specialist reports to the Patient Accounts Director and provides reporting and analysis related to payer reimbursement trends, denials, and revenue cycle performance. This role supports data-driven decision-making through detailed payer analysis, trend identification, and collaboration with revenue cycle stakeholders to improve reimbursement outcomes.
& Responsibilities Research and analyze insurance claim denials, ADR requests, recoupments, and underpayments; Utilize EMR and clearinghouse analytics tools; Identify trends and provide monthly and quarterly reports; Collaborate with admissions, billing, coding, administration, and provider liaisons; Submit and track appeals; Respond to payer and RAC audit requests; Maintain payer reference materials; Assist with special projects and complex billing issues; Maintain current knowledge of government and commercial payors; Track denial trends, perform root cause analysis, and recommend process improvements.
Education & Experience High school diploma or GED required; Associate’s or Bachelor’s degree preferred; One year experience in hospital or professional billing, medical coding, or healthcare registration preferred; Ability to type at least 30 WPM; Demonstrated verbal and written communication skills.
Knowledge of insurance billing procedures and medical terminology; Strong attention to detail; Ability to manage multiple tasks; Proficiency in Microsoft Office; Experience with billing software preferred; Strong organizational and time-management skills; Ability to maintain confidentiality and comply with HIPAA; Knowledge of ICD-10, CPT/HCPCS, medical necessity guidelines; Strong analytical and problem-solving skills; Ability to interpret payer policies and contractual language.
All candidates must be able to perform the essential functions of this position. The American with Disabilities Act (ADA) requires that reasonable accommodations be made for qualified individuals to help perform the essential functions of the position. South Central Regional Medical Center is an equal opportunity employer and does not discriminate based on race, color, religion, sex, gender, national origin, age, disability, or genetic information.