[Hiring] Payer Strategy & Analytics Senior @US Acute Care Solutions

Role Description

The Payer Strategy & Analytics Senior Finance Manager is the organization’s analytical lead for payor contracting, out-of-network reimbursement, and the arbitration and litigation processes used to resolve payment disputes. The role provides financial tracking and data-driven decision support to scale out-of-network reimbursement through No Surprises Act (NSA) Independent Dispute Resolution (IDR), state arbitration, and litigation, and to optimize payor contract outcomes.

• Serves as the key analytical partner to Payor Contracting, Revenue Cycle/AR Follow-Up, Legal, Finance, Accounting, and Operations on in-network and out-of-network reimbursement strategy.
• Builds financial models and recommendations to support payor contract negotiations, renewals, and terminations, including quantifying the impact of in-network versus out-of-network scenarios by payor and market.
• Ensures revenue recognition, budgets and forecasts are reflective of expected outcomes from IDR, arbitration, and litigation, in accordance with the Company’s revenue recognition policy.
• Owns the analytics supporting out-of-network reimbursement through the federal No Surprises Act IDR process and state arbitration programs; tracking volume, eligibility, filing deadlines, cycle time, win/loss rates, award amounts, and return on dispute cost.
• Analyzes the CMS federal IDR Public Use Files and the group’s own IDR determination data to benchmark prevailing-party rates, offers versus awards, and award-to-QPA ratios by payor, service, geography, and IDRE.
• Evaluates IDRE selection and determination patterns (fees, timeliness, and outcomes) and recommends selection and objection strategies.
• Develops and refines offer and rate strategies for IDR and arbitration submissions, including recommended offer amounts by service, payor, and market.
• Analyzes, tracks, and reports on payor contract performance; including yield per encounter, rate benchmarking (e.g., to Medicare, QPA, and commercial benchmarks), rate escalators, and underpayments.
• Partners with AR Follow-Up and Revenue Cycle leaders to prioritize work queues, optimize open negotiation and IDR initiation timing, monitor payor compliance with payment of awards, and identify process improvements that increase yield.
• Provides data analysis, underpayment and damages modeling, and exhibits in support of payor litigation and award enforcement, working closely with Legal and outside counsel.
• Monitors and interprets regulatory, legal, and industry developments (e.g., CMS rulemaking, court decisions, state law changes, and payor behavior) and communicates the potential impact to business leaders.
• Performs diligence revenue review of potential payor contracts and acquisitions, including out-of-network exposure and dispute history.
• Designs and maintains dashboards, internal performance metrics, and ad-hoc analyses, and presents insights and recommendations to business leaders in clear, actionable terms.
• Develops and implements analytics and data collection standards and processes to ensure the integrity of dispute, claims, and contract data.
• Other duties as needed.

Qualifications

• Working knowledge of the No Surprises Act, the federal IDR process, the qualifying payment amount (QPA), and state surprise billing and arbitration frameworks.
• Demonstrated ability to analyze large public and proprietary data sets (such as the CMS IDR Public Use Files) and translate findings into clear strategy recommendations.
• Strong understanding of payor contracting, fee schedules, claims adjudication, remittance and EOB data, and emergency medicine professional billing and coding.
• Strong financial acumen and advanced analytical skills, including benchmarking, forecasting, and scenario and sensitivity modeling.
• Advanced Excel, PowerPivot and a business intelligence tool (e.g., Power BI or Tableau); experience with SQL, Python, or R preferred.
• Strong business acumen and interpersonal skills.
• Excellent oral and written communication and presentation skills, including the ability to explain complex data to executives, attorneys, and non-technical partners.
• Sound judgment in handling confidential, privileged, and protected health information.
• Independently driven, with the ability to manage complex projects and achieve department goals.
• Superior time management, organizational, and problem-solving skills.

Requirements

• Bachelor’s degree in Business, Finance/Accounting, Economics, Health Policy, Informatics, or a related field, or equivalent experience (MBA or master’s preferred).
• At least 5 years of reporting, analytics, and business operations experience, preferably in the healthcare/provider space.
• At least 2 years of direct experience in payor contracting analytics, out-of-network reimbursement, or No Surprises Act IDR/state arbitration analytics.
• At least 2-3 years of leadership experience.
• Preferred: experience with emergency medicine or other hospital-based physician groups, and experience supporting litigation or arbitration with Legal and outside counsel.

Physical Demands

• While performing the duties of this job, the employee is regularly required to sit for prolonged periods and occasionally walk, stand, bend, stoop, and lift up to 15 pounds.
• Required to have close visual acuity to perform the job.

Benefits

• Medical, dental, and vision insurance options.
• Health savings accounts (HSA) and flexible spending accounts (FSA).
• 401(k) employee and employer contributions.
• Paid time off, including vacation, sick leave, and company holidays.
• Paid parental leave & family support benefits.
• Short-term and long-term disability insurance.
• Life and accidental death & dismemberment (AD&D) insurance.
• Employee assistance programs & wellness resources.
• Additional compensation may include bonus eligibility, equity, or other incentive programs, depending on the role.
• Specific benefit offerings and eligibility will be provided during the hiring process and may be subject to change in accordance with applicable laws and company policies.