Payer Strategy & Analytics Senior Finance Manager

Overview

This role serves as the organization’s analytical lead for payor contracting, out-of-network reimbursement, and the arbitration and litigation processes used to resolve payment disputes. You will provide financial tracking and data-driven decision support to scale out-of-network reimbursement through the federal No Surprises Act (NSA) Independent Dispute Resolution (IDR), state arbitration, and litigation, while optimizing payor contract outcomes.

Using CMS IDR Public Use Files and internal arbitration data, you will support decision-making on IDR entity (IDRE) selection, offer and rate strategy, and AR follow-up to maximize reimbursement yield. As the reimbursement subject matter expert, you will develop financial models and partner with Finance, Accounting, Legal, and Revenue Cycle leadership to ensure revenue projections and action plans are defensible and clearly understood.

Job Posting Closing Date: Open until Filled

Responsibilities

• Serve as a 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
• Build 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
• Ensure revenue recognition, budgets, and forecasts reflect expected outcomes from IDR, arbitration, and litigation in accordance with the organization’s revenue recognition policy
• Own 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
• Analyze CMS federal IDR Public Use Files and internal IDR determination data to benchmark prevailing-party rates, offers versus awards, and award-to-QPA ratios by payor, service, geography, and IDRE
• Evaluate IDRE selection and determination patterns (fees, timeliness, and outcomes) and recommend selection and objection strategies
• Develop and refine offer and rate strategies for IDR and arbitration submissions, including recommended offer amounts by service, payor, and market
• Analyze, track, and report on payor contract performance, including yield per encounter, rate benchmarking (e.g., to Medicare, QPA, and commercial benchmarks), rate escalators, and underpayments
• Partner 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 to increase yield
• Provide data analysis, underpayment and damages modeling, and exhibits to support payor litigation and award enforcement in coordination with Legal and outside counsel
• Monitor and interpret regulatory, legal, and industry developments (e.g., CMS rulemaking, court decisions, state law changes, and payor behavior) and communicate potential impact to business leaders
• Perform diligence revenue review of potential payor contracts and acquisitions, including out-of-network exposure and dispute history
• Design and maintain dashboards, internal performance metrics, and ad-hoc analyses, and present insights and recommendations to business leaders in clear, actionable terms
• Develop and implement analytics and data collection standards and processes to ensure the integrity of dispute, claims, and contract data
• Other duties as needed

Requirements

• 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

Education & Experience

• 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

Compensation & Benefits

Salary range: $103,887–$192,190

Salary may be determined on several factors including but not limited to knowledge, skills, experience, education, geographical location, and requirements stated in the job description.

Comprehensive benefits package may include:

• 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.

Location

Remote

Physical Demands

• 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