Payer Relations Specialist

Summary

Ovation Healthcare is a professional services company focused on strengthening independent community healthcare. The Payer Relations Specialist will support payer strategy and negotiations by analyzing reimbursement rates and evaluating the financial impact of proposed contract changes.

Responsibilities

• Collect and consolidate data from multiple sources, including databases, and spreadsheets
• Cleanse, preprocess, and validate data to ensure accuracy, completeness, and consistency
• Develop and maintain data pipelines and workflows for efficient data extraction and transformation
• Model payer contracts to evaluate the financial impact of rate change
• Simulate negotiation scenarios for Fee-For-Service and Value-Based Care models
• Analyze reimbursement trends to identify underpayments, denials, and revenue leakage
• Compare historical net revenue against proposed payer fee schedules
• Benchmark internal rates against regional market data and Medicare baselines
• Create visualizations, dashboards, and reports to present data insights in a clear and compelling manner
• Use data visualization tools such as Tableau, Power BI, or matplotlib to communicate complex data concepts effectively
• Customize visualizations to meet the needs of different stakeholders and facilitate decision-making
• Draft financial summaries to brief executives before live negotiations
• Monitor key performance indicators (KPIs) and metrics to track business performance and identify areas for improvement
• Monitor payer performance to ensure compliance with contracted terms
• Collaborate with business units to define performance benchmarks and goals
• Analyze data to identify opportunities for contract optimization and revenue enhancement
• Collaborate with cross-functional teams to support data-driven decision-making
• Provide data expertise and insights to Contract models and business projects
• Communicate findings and recommendations to stakeholders through presentations, reports, and interactive sessions
• Collaborate virtually with internal teams using secure remote communication tools

Skills

• Bachelor's degree in Finance, Business Administration, Healthcare Administration, or Statistics or a related field
• Proven experience (typically 2-5 years) in data analysis, business intelligence, or related field
• 2-5 years of experience in healthcare analytics, reimbursement, managed care, healthcare finance, or a related field
• Proficient in Excel including pivot tables, Vlook-ups, complex formulas and data validation
• Experience with Power BI and Power Point
• Familiarity with reimbursement methodologies DRG, Per Visit, APC
• Strong analytical, communication, presentation, and problem solving skills
• Ability to maintain accuracy, quality, and manage large complex data sets
• Ability to work independently and collaboratively in a fast-paced environment
• Knowledge of managed care contract language, reimbursement and healthcare payment methodologies
• Demonstrated commitment to customer service, continuous improvement, and innovative problem-solving
• Strong analytical and strategic thinking skills with exceptional attention to detail
• An advanced degree is preferred but not required
• Experience with healthcare contract modeling is strongly preferred

Qualifications

Must Haves

• Bachelor's degree in Finance, Business Administration, Healthcare Administration, or Statistics or a related field
• Proven experience (typically 2-5 years) in data analysis, business intelligence, or related field
• 2-5 years of experience in healthcare analytics, reimbursement, managed care, healthcare finance, or a related field
• Proficient in Excel including pivot tables, Vlook-ups, complex formulas and data validation
• Experience with Power BI and Power Point
• Familiarity with reimbursement methodologies DRG, Per Visit, APC
• Strong analytical, communication, presentation, and problem solving skills
• Ability to maintain accuracy, quality, and manage large complex data sets
• Ability to work independently and collaboratively in a fast-paced environment
• Knowledge of managed care contract language, reimbursement and healthcare payment methodologies
• Demonstrated commitment to customer service, continuous improvement, and innovative problem-solving
• Strong analytical and strategic thinking skills with exceptional attention to detail

Nice to Haves

• An advanced degree is preferred but not required
• Experience with healthcare contract modeling is strongly preferred