Payer Analyst

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. 

The Analyst, Payer Accountability, will educate the internal operating teams understand and navigate payer guidelines. You will research and interpret complex customer/payer contract terms in order to identify and escalate claim issues and themes related to contractual non-compliance with Payers, and partner with external or internal stakeholders to resolve them. You will understand basic concepts of hospital/physician end-to-end revenue cycle operational principles, the ability to navigate Payer guidelines, the ability to analyze, formulate, and initiate actions to resolve claims/issues, and the overall escalation of claim issues with Payers when necessary.

Essential Responsibilities

• Understand and navigate Payer guidelines (portals, manuals, contracts, etc.) 
• Research and interpret contract terms and compile necessary supporting documentation to obtain resolution of outstanding AR. 
• When appropriate, identify and escalate claim issues with Payers and external or internal stakeholders. 
• Professionally and accurately represent issues with payers, reflecting our reverence for our clients to achieve optimal outcomes for resolution.  
• Analyze data to identify and monitor payer trends, managed care/contract compliance, and operational processes specific to R1 and the respective clients being serviced. 
• Follow payer-specific guidelines for escalated claim(s) submission. 
• Work closely with leadership to optimize payer performance and resolve escalated issues efficiently. 
• Collaborate with various departments/teams to handle escalated issues and prevent future escalations where possible. 
• As applicable, provide feedback to global partners/clients, fellow associates, and other impacted departments. 
• Identify and review the root cause of escalation(s) to improve AR collections and escalation procedures. 
• Support internal and external customers by responding to and managing complaints and escalations.  
• Solve moderately complex problems and time-sensitive inquiries. 
• Decipher payer-specific escalation files with payer responses and determine the next steps to achieve resolution. 

Skills

• Self-motivator with the ability to work in remote environments with minimal supervision 
• Analytical and problem solving/critical thinking skills with attention to detail and quality at the forefront 
• Proficiency in Healthcare Reimbursement Pricing Structure and Methodologies 
• Excellent working knowledge of Revenue Cycle operations with a specific focus on Inpatient and Outpatient Managed Care and Commercial Payers 
• Proficient in Microsoft Office Suite (Word, Excel, and Outlook) 
• Ability to implement process improvements based on the directives of leadership. 
• Ability to multi-task and manage various demanding assignments that, at times, may conflict. 
• Ability to independently troubleshoot system challenges for resolution. 
• Proficient written and verbal communication skills.  

Education and Experience

High school diploma with 4-6 years relevant experience.

For this US-based position, the base pay range is $59,778.93 - $76,402.68 per year . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.

Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a competitive benefits package.

R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.

If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.

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To learn more, visit: R1RCM.com

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