Payor Relations Analyst

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

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