Payor Relations Analyst

Job description

Metro Vein Centers is a rapidly growing healthcare practice specializing in state-of-the-art vein treatments. Our board-certified physicians and expert staff are on a mission to improve people’s quality of life by relieving the painful, yet highly treatable symptoms of vein disease—such as varicose veins and heavy, aching legs. With over **70 clinics across 8 states**, and still growing, we’re building the future of vein care—delivering compassionate, results-driven care in a modern, patient-first environment. We proudly maintain a **Net Promoter Score (NPS) of 93**, the highest patient satisfaction in the industry. We are looking for a strong finance or accounting foundation paired with hands-on provider reimbursement analysis, financial modeling, and contract analysis in a managed care environment. You will turn contracts, fee schedules, and high-volume claims data into financial intelligence: modeling reimbursement, quantifying rate changes, isolating underpayments and denial patterns, and arming leadership with the numbers to negotiate from strength across 9 states. You will be an immediate contribution to a growing team. ## **What You'll Do** ### **Financial analysis & modeling** - **Contract financial modeling** – build multi-layered models forecasting the revenue impact of proposed rate adjustments, fee schedule changes, and alternative payment models (fee-for-service, capitation, value-based care, risk-sharing). - **Rate proposal analysis** – evaluate proposed rates from payors using historical utilization and claims data to project net revenue impact by market, service line, and payor. - **Reimbursement methodology analysis** – analyze payor contracts, reimbursement methodologies, and financial performance across commercial, Medicare Advantage, and Managed Medicaid books of business. - **Financial reporting & recommendations** – interpret financial and reimbursement reports, build scenario and sensitivity analyses, and deliver actionable recommendations to leadership. ### **Contract performance & reimbursement integrity** - **Contract yield auditing** – track overall yield across commercial, Medicare Advantage, and Managed Medicaid plans to ensure payors reimburse according to executed agreements. - **Underpayment & variance identification** – isolate underpayments, payment variances, and contract non-compliance by analyzing claim outcomes against expected contractual terms, then quantify the exposure and drive recovery. - **Fee schedule & system fee mapping** – maintain and audit contract configuration, fee schedules, and reimbursement matrices in the EHR/practice management and RCM systems with rigorous accuracy and version control. - **Renewal readiness** – track contract expiration and escalator timelines so negotiation strategy begins well ahead of every deadline. ### **Contract negotiation support** - **Negotiation modeling** – partner with Payor Relations leadership to evaluate proposed reimbursement structures and build the financial case behind every ask. - **Financial impact assessment** – quantify the impact of new contracts, amendments, renewals, and reimbursement changes before and after execution. - **Analytical support** – support internal stakeholders throughout the contracting lifecycle, from initial modeling through post-signature validation. ### **Reporting, dashboards & executive communication** - **Executive support** – synthesize high-volume claims data, denial trends, and payment metrics into dashboards, briefing packets, and scenario analyses for the Senior Manager and Director, tracking payor mix, weighted-average rate increases, and contract timelines. - **Present to leadership** – explain complex financial findings to business leaders clearly and connect the numbers to the decision in front of them. - **Data accuracy & integrity** – own the accuracy of every analysis, including source data validation and reconciliation to system of record. ### **Payor relationship management & operations** - **Day-to-day payor contact** – serve as an operational point of contact for provider relations representatives across assigned health plans, resolving systemic claim issues and administrative friction. - **Joint Operating Committees** – prepare analytical agendas and performance data packets, and track actionable follow-ups for recurring JOC meetings with health plan representatives. - **Denials root-cause & permanent fixes** – partner with Patient Access, Billing, Coding, and Denial Management on root-cause analysis of recurring rejections, then establish process changes that prevent them from returning. - **Payor policy & market awareness** – monitor administrative updates, medical coverage policy changes, and pre-authorization requirements; communicate operational impact to RCM, Billing, and Clinical teams as we scale into new markets. ### **Cross-functional collaboration** - Collaborate with Finance, Credentialing, RCM, Billing, and Operations to translate financial data into strategic recommendations. - Identify opportunities to improve financial performance, reimbursement strategy, and operational efficiency across the organization. ## **Qualifications** ### **Education & healthcare experience** - Bachelor's degree in Finance, Accounting, Economics, Healthcare Administration, Business Analytics, Health Information Management, or a related field, or equivalent practical experience. - **3-5+ years** of progressive healthcare financial analysis experience in provider reimbursement, payor relations, managed care, revenue cycle analysis, or healthcare financial/business analytics. Healthcare experience is required. - Provider, MSO, or multi-state specialty group experience preferred; health plan, MCO, or payer-side reimbursement experience also considered. - Strong finance or accounting foundation with demonstrated ability to interpret financial statements, reimbursement reports, and contract economics. - Demonstrated experience performing financial modeling, provider reimbursement analysis, and provider contract financial analysis. - Experience supporting contract negotiations through financial analysis and modeling. - Strong working knowledge of reimbursement methodologies (fee-for-service, capitation, value-based care), coding standards (CPT, ICD-10, HCPCS), and revenue cycle workflows. - In-depth understanding of commercial payor structures, Medicare Advantage, and Medicaid fee-for-service and managed care variations across states. ### **Technical & analytical proficiency** - **Advanced Excel (required)** – complex data manipulation with dynamic functions, pivot tables, nested logic, financial modeling, forecasting, and scenario analysis. - **Business intelligence & querying (preferred)** – SQL, Power BI, or Tableau used to analyze healthcare claims and financial datasets and build dashboards. SQL is strongly preferred. - **EHR & payor platforms** – experience with major EHR/billing software and health plan portals (Availity, CAQH). - **Presentation skills** – able to explain financial data to business leaders in clear, decision-ready terms. ### **Preferred** - Experience in a rapidly growing MSO, specialty medical group, ASC, or multi-state provider environment. - Contract-modeling and analytics platforms such as Rivet; familiarity with multi-state credentialing and enrollment. - Knowledge of value-based care, risk arrangements, and payor quality programs. ## **Core Competencies** - **Analytical rigor** – you reason from the data, pressure-test your own numbers, and can defend every figure you put in front of leadership. - **Business acumen** – you connect quantitative findings to real healthcare operations, clinical workflows, and revenue cycle impact. - **Upward communication** – you package complex datasets and contract terms into straightforward summaries for senior leadership. - **Proactive problem-solving** – a self-starter who finds root causes and drives resolution with internal teams and external payors alike. - **Precision & ownership** – accuracy is non-negotiable, and you juggle multiple projects and analysis at once. ### **Benefits to Support Your Wellbeing & Lifestyle** Full-time team members at Metro Vein Centers are eligible for: - Medical, Dental, and Vision Insurance - 401(k) - Paid Time Off (PTO) + Paid Company Holidays - Company-Paid Life Insurance - Short-Term Disability Insurance - Employee Assistance Program (EAP) - Career Growth & Development Opportunities #Li-Remote **The Metro Vein Centers Difference** **Healthy legs. Happier lives.** At Metro Vein Centers, we believe exceptional care begins with an exceptional experience. Our mission is to make vein care approachable, empowering, and connected to overall well-being. From the first conversation to the final follow-up, every patient interaction reflects our commitment to compassion, expertise, and trust. **A team united by purpose.** Our values guide everything we do: - **Patients First, Always** – Every interaction should make our patients feel valued, heard, and cared for. - **Stronger Together** – Teamwork and collaboration drive our success. We lift each other up to deliver the best for our patients. - **A Can-Do Spirit** – We meet every challenge with positivity, flexibility, and problem-solving energy. - **Results That Make a Difference** – We’re driven to improve lives through meaningful, measurable outcomes. - **Commitment to Growth** – We invest in our people, fostering advancement and professional development at every level. **Metro Vein Centers is an Equal Opportunity Employer.** We’re committed to creating a workplace where everyone feels seen, heard, and supported. We do not discriminate based on race, color, religion, sex, national origin, age, disability, genetics, gender identity or expression, sexual orientation, veteran status, or any other protected status in accordance with applicable federal, state, and local laws. This policy applies to all aspects of employment, including recruitment, hiring, promotion, compensation, benefits, and termination. **Legal & Compliance Notice:** Metro Vein Centers complies with all applicable federal, state, and local employment laws, including those related to nondiscrimination, equal opportunity, and pay transparency. Where specific disclosures or postings are required by law, we provide this information as part of our hiring process or upon request. **Your privacy matters.** To learn more about how we collect, use, and protect your information, please review our privacy policy [here](https://www.metroveincenters.com/privacy-policy).