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Payer Payment & Reimbursement Analyst - Remote/Nationwide

Signature Performance, Inc.

Seattle, WA(remote)

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JOB DETAILS
SALARY
$93,000–$99,000 Per Year
JOB TYPE
Full-time, Employee
SKILLS
Acceptance Testing, Adjudication, Analysis Skills, Communication Skills, Cost Control, Customer Support/Service, Data Sets, Detail Oriented, Federal Government, Government, Healthcare, Healthcare Administration, Healthcare Providers, Healthcare Reimbursement, Internet Research, Legal, Logic Testing, Medical Billing, Mentoring, Microsoft Access Database, Microsoft Excel, Microsoft Office, Microsoft PowerPoint, Microsoft Visio, Microsoft Word, Multitasking, Philosophy, Pricing, Problem Solving Skills, Project/Program Management, Quality Assurance, Reconciliation, Regulations, Reimbursement, Reporting Skills, SQL (Structured Query Language), Software Design, Systems Administration/Management, Systems Analysis, Systems Maintenance, Team Player, Test Data, Test Plan/Schedule, Testing, Time Management, Training/Teaching, Trend Analysis, United States Citizen, Vendor/Supplier Evaluation
LOCATION
Seattle, WA
POSTED
30+ days ago
This is a remote based position. Applicants can be located nationwideBack

Payer Payment & Reimbursement Analyst
#2650
United States
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Position Description

About You

The Payer Payment and Reimbursement Analyst will work with the team members in healthcare payment & reimbursement methodologies, laws and regulations under the mentorship and guidance of the Project Manager.


Tell us about your experience with Payer Payment and Reimbursement Analysis.
Are you a team player and a self-motivator?
What is your experience with conducting business in a way that is credit to a company?
We are counting on you to manage multiple projects using your problem-solving skills.
We are looking for someone UNCOMMON. What is uncommon about you?

Are you highly committed? Are you team-oriented? Do you value professionalism, trust, honesty, and integrity? If so, we cannot wait to meet you.

About the Position


Configure and maintain payment, pricing, and contract logic within healthcare reimbursement systems to ensure accurate claims adjudication.
Analyze vendor bulletins, regulatory updates, and system changes to assess impact on internal processes, products, and data systems.
Review and evaluate large healthcare data sets to identify trends, anomalies, and required system or process changes.
Interpret Medicare, VA, CHAMPVA, and TRICARE policies, including rulings, transmittals, bulletins, manuals, and physician fee schedule data files.
Collaborate directly with government agencies to clarify new or existing reimbursement and payment policies.
Translate reimbursement policy updates and payment methodology changes into clear, actionable business requirements for software design and system configuration.
Develop complex Excel models and formulas to validate, explain, and support payment methodologies.
Identify claim data characteristics required for testing pricing logic and configuration accuracy.
Partner with Developers, QA, Data, and Client Services teams to ensure requirements are implemented accurately and on schedule.
Create and execute test claims for development, UAT, QA, and configuration validation.
Perform configuration testing and troubleshoot pricing or payment discrepancies.
Maintain deep knowledge of company products, data, and services, including commercial contracting and reimbursement features.
Independently evaluate and resolve complex pricing and reimbursement issues while managing multiple priorities.

Core Competencies


Strong analytical and critical-thinking skills
High attention to detail and quality
Ability to synthesize complex policy and data into practical solutions
Effective collaboration and communication
Self-directed with strong prioritization skills

Minimum Requirements


3-4 years of professional experience in healthcare provider payment and reimbursement.
Working knowledge of healthcare billing, compliance, and payer reimbursement regulations.
Experience with professional and institutional payment fee schedules, including but not limited to:
Experience with Prospective Payment Systems (PPS), including:


DRG, OPPS, Skilled Nursing, Home Health, Hospice, and ASC

Knowledge of:


Critical Access, Sole Community
Behavioral Health
Inpatient Rehabilitation/Outpatient Rehabilitation
Long Term Care Hospital
Federally Qualified Health Center
Physician Fee Schedule, DME/DEMPOS, Ambulance, AWP, Lab, ESRD, Hospice, Home Health, Anesthesia, ADA
Integrated Outpatient Code Editor (I/OCE)

Ability to collect, research, interpret, and document complex information into clear and concise business requirements.
Strong interpersonal and cross-functional collaboration skills.
Working knowledge of provider types, specialties, and their applicable reimbursement methodologies.
Ability to communicate effectively with diverse internal and external stakeholders.
SQL reporting experience preferred.

Preferred Requirements


Proficiency in Microsoft Office applications (Teams, Word, Excel, PowerPoint, Visio, Access).
Experience using web-based research tools and regulatory resources.
Knowledge of claims adjudication and payment workflows.
Experience configuring TriZetto Facets NetworX.
Experience configuring Optum Rate Manager.

About Us

You are uncommon. We are, too. We are looking for people to help us in our mission of working hard at lowering healthcare administrative costs for federal government agencies, payers, and providers. At Signature, our mission is to improve the health of our clients' business and make the lives of the people we work with better. As we continue to experience exponential growth, we are looking for uncommon individuals to enhance our vision. We will continue to accomplish our mission by leading with our values of Passion, Courage, Integrity, and Respect in all interactions, making us a consistent annual Best Places to Work organization. We need uncommon leaders with uncommon qualities to shape our uncommon culture and achieve our uncommon mission.

About the Benefits

When you are a member of Signature Performance, you are a part of a solutions-based organization where the values of passion, integrity, courage, and respect are the driving forces behind all our decision-making. We trust you to do important work and bring the best version of yourself to work every day, so we want to help you achieve a work-life balance while consistently challenging yourself. Signature believes in fully developing each one of our Associates. Our performance-driven philosophy boasts competitive pay and additional position specific incentives, where world-class training and development, resources, and events drive our award-winning culture where everyone thrives.


Health Insurance
Fully Paid Life Insurance
Fully Paid Short- & Long-Term Disability
Paid Vacation
Paid Sick Leave
Paid Holidays
Professional Development and Tuition Assistance Program
401(k) Program with Employer Match

Security Requirements


U.S. Citizenship or naturalized citizenship is required for this position.
All work on all positions at Signature Performance must be completed in the continental United States, Alaska, or Hawaii.

Work Schedule
Monday - Friday 8:00a - 5:00p CST

Compensation Range
$93,000 - $99,000/Annually

Position Type
Full Time

This Company is an Equal Opportunity Employer, and does not discriminate on the basis of race, gender, ethnicity, religion, national origin, age, disability, veteran status, or on any other basis prohibited by law. Information on race, gender and national origin will only be used for statistical and recordkeeping purposes, and will not be used in making any employment decisions. All information provided will be kept separate from your expression of interest. Providing this information is strictly voluntary, and you will not be subjected to any adverse action or treatment if you choose not to provide this information. If you do not choose to answer these questions, we ask that you select "Decline to Identify" for each question. Thank you for your voluntary cooperation.

About the Company

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Signature Performance, Inc.