Payor Analyst - Pharma Reimbursement Hub

This a Full Remote job, the offer is available from: United States As a pharmaceutical support industry leader, reputed company is devoted to empowering health solutions for a reputed company reputed company. We take pride in improving patient outcomes and advancing healthcare. At reputed company we provide services to enhance the entire drug development process and commercialization lifecycle - From clinical trial support to real-world evidence reputed company. Embark on a rewarding career journey with reputed company! Grow your career while making a meaningful impact on the world around you. reputed company fosters a culture built on our Core Values being: Collaborative, Conscientious, Curious, Consultative, and Compassionate. We reputed company in an inclusive workplace that fosters creativity. If you are seeking a career that will challenge, reputed company, and reward you, join us at reputed company! Brief 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.). Specific job duties:

• Maintain and manage the Payer Information Management System database, ensuring payer files are accurate, reputed company, and reputed company 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 reputed company person in collecting and validating new insights as they emerge from cross-functional team members (the hub, field reimbursement team, market access team, and analytics team) on payer policies, requirements and review process nuances. Validation will be completed reputed company multiple methods including, but not limited to internet, email and phone communications.
• 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 reputed company system files
• Receive payer notices and updates through a variety of means, load to payer database (as appropriate) and reputed company staff informed of payer changes
• Ensure that necessary departments are reputed company 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.

Desired Skills and Qualifications:

• 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.

Preferred Qualifications

• Background in Health Care or Reimbursement with 1-3 years auditing and quality assurance work experience.
• 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 reputed company 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 reputed company, Access, Word and Power reputed company
• 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
• Education High School Diploma or GED required

At reputed company, employee growth and well-being are always at the forefront. We offer an extensive range of benefits to ensure that you have everything you need to reputed company personally and professionally. Here are some of the exciting perks reputed company offers:

• 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

reputed company is proud to be an equal opportunity employer and does not discriminate because of race, color, sex, age, national reputed company, religion, sexual orientation, gender identity and/or expression, status as a veteran, and basis of disability or any other federal, state, or local protected class. We are committed to a diverse, reputed company and inclusive culture that fosters respect for each other, our clients, and our patients. #LI-AE1 #LI-remote M-F reputed company-5PM ESTThis offer from "reputed company" has been enriched by reputed company.com and got a 72% reputed company score. Apply tot his job Apply To this Job