Job Overview

The Payor Analyst plays a critical role in identifying, analyzing, and resolving payer-related claims issues to support timely and accurate reimbursement. This position is responsible for coordinating both known and newly reported claims issues through data research, trend analysis, and root cause identification. The goal is to consolidate findings, report insights, and enable resolution of payer challenges across the revenue cycle. Success in this role will be measured by the timeliness and resolution rate of payer-related issues.

Responsibilities

• Claims Payer Issue Coordination & Analysis
• Perform detailed account reviews and root cause analysis of payer-specific trends and denials.
• Prepare mitigation strategies and documentation for leadership and payer submission.
• Aggregate and analyze data to identify systemic issues and support payer resolution efforts utilizing Excel, Epic, PowerBI and denial reporting data.
• Documentation & Reporting
• Collaborate with Revenue Cycle leadership to document, quantify, and consolidate issues for payer submission.
• Ensure all documentation is complete, accurate, and aligned with payer requirements.
• Facilitate monthly payer meetings, including agenda preparation, attendance tracking, and capturing and distribution of meeting notes.
• Subject Matter Expertise
• Maintain comprehensive knowledge of payer requirements, reimbursement policies, and claims resolution processes.
• Stay current with Payer bulletins to apply payer policies to denied claims for timely and appropriate payment processing.
• Support both macro and micro-level issue resolution, including gaps and delays in payment.
• Communicate effectively across departments with supporting documentation for all payer-related issues.
• Leadership Support & Training
• Assist leadership in delivering closed-loop communication, feedback, and training to improve departmental efficiency.
• Promote best practices in claims resolution and payer engagement.
• Quality & Productivity Monitoring
• Conduct staff productivity and quality checks in accordance with departmental policies and business unit standards.
• Review complex technical and professional billing and collections processes to ensure accuracy and compliance.
• Organization Expectations, as applicable:
• Demonstrates ability to provide care or service adjusting approaches to reflect developmental level and cultural differences of population served. o Communicates in a respective manner. o Ensures a safe, secure environment.
• Fulfills all organizational requirements. o Completes all required learning relevant to the role. o Complies with and maintains knowledge of all relevant laws, regulations, policies, procedures and standards.

Required Qualifications

• 3 years experience in a medical billing office with billing or collections experience
• MS Office experience
• Insurance Follow-up Experience
• Coordination of Benefits Experience

Preferred Qualifications

• B.S./B.A.
• 5 years 5 years healthcare experience related to billing, coding, reimbursement, and knowledge of payment methodologies of commercial and government payors
• Epic Experience
• Experience with medical terminology, CPT and ICD-10 coding knowledge
• Knowledge of FV account review experience
• Knowledge of FV system applications

 

Benefit Overview

Fairview offers a generous benefit package including but not limited to medical, dental, vision plans, life insurance, short-term and long-term disability insurance, PTO and Sick and Safe Time, tuition reimbursement, retirement, early access to earned wages, and more! Please follow this link for additional information: https://www.fairview.org/careers/benefits/noncontract

Compensation Disclaimer

An individual's pay rate within the posted range may be determined by various factors, including skills, knowledge, relevant education, experience, and market conditions. Additionally, our organization prioritizes pay equity and considers internal team equity when making any offer. Hiring at the maximum of the range is not typical. If your role is eligible for a sign-on bonus, the bonus program that is approved and in place at the time of offer, is what will be honored.
EEO Statement

EEO/Vet/Disabled: All qualified applicants will receive consideration without regard to any lawfully protected status