Overview
The Payor Pricing Analyst role focuses on building, maintaining, and optimizing financial models that support payor contract strategy. This position serves as the quantitative resource behind fee schedule negotiations, reimbursement benchmarking, and revenue impact modeling for all contracted and non-contracted payors. The ideal candidate has advanced modeling skills and can translate complex payor data into clear, actionable insights for negotiations.
Responsibilities
Financial & Reimbursement Modeling
- Build and maintain dynamic fee schedule models across UCR, Medicaid, Medicare Advantage, and commercial payor contracts
- Develop multi-scenario revenue impact models to evaluate proposed fee changes and network participation decisions
- Create annual reimbursement benchmarking analyses comparing contracted rates to FAIR Health, ADA fee surveys, and internal production data
Payor Contract Analysis & Negotiation Support
- Prepare negotiation briefs including modeled rate ask scenarios, walk-away thresholds, and estimated uplift
- Track contract lifecycles, renewal timelines, and amendment history for all payor relationships
- Support leadership with data packages for payor meetings, including trend analyses and competitive positioning
- Act as primary liaison between Fee Schedule and Payor Pricing teams to ensure timely and accurate communication of effective dates, fee updates, and new schedule implementations
Data Infrastructure & Reporting
- Develop ad hoc models for executive decision-making such as payor mix optimization and pricing strategy
Work Environment
This is a fully remote position requiring a home-based professional setting with substantial digital collaboration.
Physical Demands
The role involves sustained computer and desk work with prolonged sitting, regular virtual communication, and occasional light lifting of typical home-office items.
Competencies
- Financial Analysis & Modeling: Ability to analyze reimbursement data, build financial models, and assess revenue impact of payor contract changes
- Payor Reimbursement Expertise: Knowledge of dental insurance reimbursement methodologies, fee schedules, and contract structures
- Data Analytics: Skilled at interpreting large datasets, identifying trends, and translating findings into actionable business insights
- Strategic Thinking: Evaluates financial opportunities and risks to support contract negotiations and reimbursement optimization
- Problem Solving: Investigates reimbursement variances, identifies root causes, and develops effective solutions
- Communication Skills: Clearly presents complex financial information and collaborates effectively with cross-functional stakeholders
- Attention to Detail: Ensures accuracy in financial models, fee schedules, contract analysis, and reporting
- Collaboration: Builds strong partnerships across Revenue Cycle, Finance, Operations, Credentialing, and Leadership teams
- Business Acumen: Understands how reimbursement strategies impact organizational performance and profitability
- Continuous Improvement & Accountability: Demonstrates initiative in enhancing processes, reporting, and reimbursement performance while taking ownership of results
Qualifications
- High School Diploma or Equivalent required
- 3+ years of experience in dental revenue cycle, payor contracting, or healthcare financial analysis
- Advanced Excel proficiency including financial modeling, pivot tables, VLOOKUP/INDEX-MATCH, scenario analysis, and dynamic dashboards
- Experience analyzing fee schedule data at scale
- Proven ability to build models that drive business decisions rather than just report data
- Strong written and verbal communication skills with the ability to present analytical findings to leadership