Payor Analyst – Pharma Reimbursement Hub
Posted 2026-05-06
Remote, USA
Full-time
Immediate Start
- Job Description:
- 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