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New York University

Dental Insurance Analyst

New York, NY · On-site

$71.44K - $87.31K/yr

Analyze, audit and recover outstanding receivables. Identify trends in payments, underpayment ... Contact payer to resolve appeals and final solution to claims. Collaborate with the Director of ...

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How much do payer analyst jobs pay per hour?

As of Jun 1, 2026, the average hourly pay for payer analyst in the United States is $30.38, according to ZipRecruiter salary data. Most workers in this role earn between $20.43 and $36.06 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Payer Analyst, and why are they important?

To thrive as a Payer Analyst, you need a solid understanding of healthcare reimbursement, claims processing, and analytical skills, typically supported by a degree in healthcare administration, finance, or a related field. Familiarity with claims management systems, data analytics tools like Excel or SQL, and knowledge of payer policies and regulations are essential. Strong attention to detail, problem-solving abilities, and effective communication help you interpret complex data and collaborate with stakeholders. These skills are vital for ensuring accurate reimbursement, optimizing revenue cycles, and maintaining compliance in healthcare organizations.

What are the typical challenges faced by a Payer Analyst when working with insurance claims data?

Payer Analysts often encounter challenges related to the complexity and variability of insurance claims data, such as dealing with inconsistent coding, missing information, and navigating different payer requirements. They must pay close attention to detail to identify discrepancies and trends that may impact reimbursements or compliance. Effective communication with both internal teams and external payers is crucial, as resolving issues often requires collaboration across departments and clear documentation. Staying updated on regulatory changes and payer policies is also key to ensuring accurate analysis and reporting.

What is a Payer Analyst?

A Payer Analyst is a professional who works within healthcare organizations to analyze and manage relationships with insurance companies and other payers. Their primary responsibilities include reviewing payer contracts, monitoring reimbursement rates, and ensuring compliance with payer policies to optimize revenue cycle performance. They also identify trends in claim denials and help implement strategies to improve payment outcomes. Payer Analysts play a key role in maximizing revenue and maintaining strong payer-provider relationships within the healthcare industry.

What is the difference between Payer Analyst vs Claims Analyst?

AspectPayer Analyst

Required CredentialsTypically a bachelor’s degree in healthcare, finance, or related field; certifications like CPC or CCS may be preferred.

Work EnvironmentPrimarily office-based, working with insurance companies, healthcare providers, and billing systems.

Employer & IndustryHealthcare insurance companies, third-party administrators, and healthcare providers.

While both roles involve healthcare data, a Payer Analyst focuses on analyzing payer policies, reimbursement processes, and claims data to optimize revenue. A Claims Analyst primarily reviews and processes insurance claims to ensure accuracy and compliance. The roles often overlap in healthcare insurance settings but differ in focus: one on payer strategies and the other on claims processing.

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What job categories do people searching Payer Analyst jobs look for? The top searched job categories for Payer Analyst jobs are:
Payer Analyst jobs near you
Vice President & Head of Payer Strategy

Vice President & Head of Payer Strategy

PM Pediatric Care

Remote

Full-time

Posted 4 days ago

PM Pediatric Care rating

6.6

Company rating: 6.6 out of 10

Based on 18 frontline employees who took The Breakroom Quiz

Job description

It's fun to work in a company where people truly BELIEVE in what they're doing!
We're committed to bringing passion and customer focus to the business.
Summary
**This is a remote position, but must reside in the Northeast**
PM Pediatric Care is scaling a behavioral health platform to address the mental health crisis facing children and adolescents. We operate state-based clinical pods across New York, New Jersey, and Florida, with national expansion underway. Over the next 24 months, we are growing from 75K to 150K+ annual visits and $15M to $50M+ in revenue.
The VP & Head of Payer Strategy is the enterprise payer strategist and chief negotiator for PM Pediatric Care's Urgent Care and Behavioral Health service lines. This role owns national payer relationships, contract strategy, rate negotiations, multi-state expansion, and value-based partnership development. You will serve as the executive voice to Tier 1 payers, BCBS plans, Medicaid programs, and value-based care organizations.
You will operate at the intersection of clinical strategy, financial performance, and market access, translating clinical quality and patient outcomes into payer value propositions, negotiating contracts that balance network inclusion with financial sustainability, and building partnerships that position PM Pediatrics for long-term advantage.
Reports to: Chief Commercial Officer. Partners closely with: SVP Operations (Urgent Care and Behavioral Health), VP Clinical Programs, Finance/FP&A, and Revenue Cycle Management.
This is a high-visibility executive role with direct exposure to the CEO, Board of Directors, and national payer C-suites.
Description
Responsibilities
National Payer Strategy & Tier 1 Relationship Leadership (Urgent Care) - 40%
  • Own strategic relationships with Tier 1 payers: UnitedHealthcare, Aetna, Cigna, Anthem/BCBS, and Humana; serve as executive liaison to payer leadership at the C-suite and senior VP levels

  • Negotiate multi-year rate renewals, expand geographic coverage, and improve contract terms including facility fees, after-hours differentials, and coding/billing policies

  • Lead escalation management: resolve contract disputes, address network adequacy issues, and navigate audit and compliance challenges

  • Translate clinical quality, patient satisfaction, and cost-effectiveness into compelling payer value propositions

  • Analyze rate structures, benchmark against market, and identify opportunities for rate improvement

  • Align contract strategy with operational footprint, utilization patterns, and market expansion plans in partnership with SVP Urgent Care Operations

Behavioral Health Contract Expansion & Multi-State Market Entry - 35%
  • Accelerate behavioral health payer contracting in NY, NJ, and FL, and lead payer entry into 6+ new states over 24 months

  • Negotiate rates, terms, and coverage policies that support financial sustainability, with a target of $200K-$280K revenue per clinical FTE

  • Lead payer credentialing and network inclusion strategy for therapists, psychiatrists, and psychiatric NPs across multiple states; drive credentialing cycle time to under 45 days

  • Navigate state-specific contracting landscapes including Medicaid managed care, state employee health plans, regional commercial payers, and telehealth reimbursement policies

  • Leverage urgent care relationships to unlock behavioral health contracting opportunities using an integrated care value proposition

  • Design and execute a behavioral health payer entry playbook covering market landscaping, contract negotiation sequencing, credentialing project management, and post-contract optimization

Value-Based Care & Strategic Partnership Development - 20%
  • Evaluate and build value-based care partnerships: shared savings, bundled payments, quality incentive programs, and outcomes-based contracts

  • Lead strategic payer pilots including integrated care models, SDOH collaborations, pediatric behavioral health integration, and alternative reimbursement models

  • Design clinical-financial frameworks for value-based arrangements, including quality metrics, financial risk models, and performance monitoring

  • Model upside/downside scenarios for value-based contracts in partnership with Finance and Clinical Leadership

  • Position PM Pediatrics for emerging payment models: CMS Innovation Center initiatives, Medicaid value-based purchasing, and payer-provider SDOH collaborations

  • Identify strategic payer partnership opportunities beyond traditional contracting, including data sharing, care coordination platforms, and referral network integrations

Payer Analytics, Performance & Cross-Functional Leadership - 5%
  • Build payer performance dashboards tracking contract utilization, revenue per contract, payer mix, claims denial rates, and financial performance by payer

  • Benchmark PM Pediatrics rates and contract terms against urgent care and behavioral health competitors

  • Lead cross-functional payer governance in partnership with RCM, Finance, and Operations

  • Develop negotiation playbooks, contract templates, and rate benchmarking tools to scale the payer strategy function

  • Build and lead the payer strategy team as the organization scales, including future hires in payer contracting, credentialing, and analytics

  • Drive $15M-$25M in cumulative revenue impact through contract optimization, new payer partnerships, and value-based upside

Target Compensation: $220,000 - $275,000
The salary/rate range listed here has been provided to comply with local regulations and represents a potential base salary/rate for this role. Please note that actual salaries/rates may vary within this range above or below, depending on experience and location. We look at compensation for each individual and based on experience and qualifications.
Qualifications
Qualifications
Required
Payer Strategy & Contracting
  • 10+ years in healthcare payer strategy, network contracting, or health plan partnerships with progressive responsibility

  • 5+ years in senior leadership roles (VP, SVP, or Director-level) with direct accountability for payer negotiations, contract performance, or network strategy

  • Proven track record of building and leveraging executive-level relationships with UnitedHealthcare, Aetna, Cigna, Anthem/BCBS, Humana, or equivalent Tier 1 payers

  • Direct experience negotiating multi-million dollar payer contracts with measurable results: rate improvements, contract wins, revenue growth

Multi-Site & Multi-State Healthcare
  • Experience in multi-site healthcare settings: urgent care, behavioral health, outpatient specialty, or retail healthcare

  • Multi-state contracting experience including Medicaid managed care, telehealth reimbursement policies, and regional BCBS plans

  • Provider credentialing expertise: CAQH, payer enrollment processes, and multi-state licensure requirements

Financial & Analytical Skills
  • Strong financial modeling: contract rate analysis, market benchmarking, revenue impact modeling, and value-based care financial risk assessment

  • Comfort with payer analytics, claims data, utilization reports, and contract performance dashboards

  • P&L orientation: demonstrated ability to translate payer strategy into revenue growth, margin improvement, and payer mix optimization

Value-Based Care & Strategic Partnerships
  • Experience designing or negotiating value-based arrangements: shared savings, bundled payments, quality incentives, outcomes-based contracts, or population health models

  • Familiarity with clinical quality metrics: HEDIS, NCQA, patient satisfaction, clinical outcomes, and cost-effectiveness

  • Strategic partnership development beyond traditional contracting: SDOH collaborations, pilot programs, innovation initiatives

Leadership & Communication
  • Executive presence: ability to build credibility with payer C-suites, internal executives, and board members

  • Proven negotiation skills in complex, multi-party situations

  • Strong written, verbal, and presentation skills for executive reporting and board-level updates

  • Ability to lead cross-functionally across Operations, Clinical, Finance, and RCM without direct authority

Preferred
Industry Background
  • Urgent care contracting experience: reimbursement models, facility fees, coding/billing policies

  • Behavioral health contracting: therapist/psychiatrist reimbursement, telehealth policies, outcomes-based contracting

  • Pediatric healthcare: pediatric care models, family-centered care, pediatric quality metrics

Additional Qualifications
  • MBA, MHA, JD, or equivalent advanced degree in business, healthcare administration, or law

  • Prior consulting experience at top-tier healthcare strategy firms (McKinsey, Bain, BCG, Accenture, Navigant/Guidehouse)

  • Former health plan experience at UnitedHealthcare, Aetna, Cigna, Anthem, Humana, or a regional health plan in network strategy, provider relations, or medical management

  • CMS or state Medicaid experience: Medicare Advantage, Medicaid managed care, or public payer programs

  • Telehealth reimbursement expertise: interstate contracting, evolving telehealth policies, and virtual care reimbursement

Compensation:
Role Dependent
The salary/rate range listed here has been provided to comply with local regulations and represents a potential base salary/rate for this role. Please note that actual salaries/rates may vary within this range above or below, depending on experience and location. We look at compensation for each individual and based on experience and qualifications.
EEO Statement
PM Pediatric Care is an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, disability status, protected veteran status or any other characteristic protected by law.

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