Payer Data Analyst

Education / Licensing Requirements:

Bachelor’s degree in Health Informatics, Data Science, Finance, or related field

Experience Requirements:

2-5+ years of experience with healthcare data, specifically medical/pharmacy claims and payer-specific structures (e.g., ICD-10, NDC).

Position Overview:

Responsible for managing, analyzing, and ensuring the quality of healthcare payer data (claims, provider networks, reimbursement) to support reimbursement, contract modeling, and financial reporting.

Positions reporting to this position: Direct reports: None

Essential Skills/Experience

Organizational skills

Proven time management skills

Advanced MS Excel

Excellent attention to detail

Experience with SQL and Power BI

Strong analytical and problem-solving ability

Proven ability to prioritize and multi-task

Characteristics

Sense of urgency

Organized, detail oriented; catches errors early

Ethical; respects confidentiality

Responsibilities:

§ Review and model managed care contracts to ensure reimbursement accuracy and profitability.

§ Develop, approve, and maintain financial models to forecast operational expenses and revenue.

§ Analyze member/patient data, claims, and provider utilization to identify cost-saving and growth opportunities.

§ Monitor monthly contract performance, publish performance reports, and track KPIs against financial targets.

§ Utilize SQL and BI tools (e.g., Power BI) to manage large, complex healthcare datasets.

§ Develop and maintain dashboards, run ad-hoc queries, and produce financial reports regarding payer performance, reimbursement rates, and claims trends.

§ Analyze payer contract terms to support negotiations, model expected vs. actual revenue and identify opportunities for reimbursement optimization.

§ Act as the subject matter expert (SME) on payer data for internal teams (finance, operations, business development) and external stakeholders (PBMs, health plans)

§ Performs other incidental and related duties as required.

Working Conditions:

§ Fast-paced environment.

§ Requires normal vision (corrected) both close and distant.

§ Requires normal hearing levels (corrected).

§ Requires working at a desk to use a phone and computer for extended periods of time. Requires sitting, bending.

§ Works effectively with frequent interruptions.

§ Minimal travel <10%.

Job Type: Full-time

Pay: $80,000.00 per year

Benefits: