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Payor Analyst Jobs in Wisconsin (NOW HIRING)

0090 Presbyterian System Services

WI · On-site

$150 - $180/hr

The leader will define and execute a system‑wide payor contracting and revenue optimization ... Analyze reimbursement trends and implement targeted interventions to address risk areas and improve ...

ASPIRUS HEALTH

PRESIDENT- ASPIRUS NETWORK INC

Wausau, WI · On-site

... payor requested quality initiatives that will transform ANI and the Aspirus healthcare system into ... Possesses strong analytical and presentation skills. * Functions well under pressure and is an ...

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Payor Analyst information

What are the key skills and qualifications needed to thrive as a payor analyst?

To thrive as a Payor Analyst, you need a solid understanding of healthcare reimbursement, contract analysis, and data analytics, typically supported by a degree in finance, healthcare administration, or a related field. Familiarity with claims processing systems, payer portals, and advanced Excel or data management tools is commonly required. Strong attention to detail, analytical thinking, and effective communication are vital soft skills for interpreting complex data and collaborating with stakeholders. These skills are crucial for maximizing revenue, ensuring compliance, and optimizing payor relationships in a healthcare setting.

What is a payor data analyst?

A payor data analyst is a professional who analyzes healthcare payer data, such as insurance claims and billing information, to identify trends, improve processes, and support financial decision-making. They often use data analysis tools like Excel, SQL, or specialized healthcare software and require strong analytical skills and knowledge of healthcare billing and coding. This role is essential in managing payer relationships and ensuring accurate reimbursement processes.

What does a payor analyst do?

A Payor Analyst is responsible for analyzing and managing relationships between healthcare providers and insurance companies (payors). They review contracts, track payment trends, identify discrepancies in claims, and ensure that reimbursements are accurate and timely. Payor Analysts also provide data-driven insights to help healthcare organizations optimize revenue cycles and negotiate better terms with insurers. Their work supports financial stability and helps resolve issues related to denied or underpaid claims.

How does a payor analyst typically collaborate with other departments to resolve reimbursement issues?

Payor Analysts often work closely with billing, coding, and revenue cycle teams to address reimbursement discrepancies and ensure timely payments from insurance companies. They analyze payment data, investigate denials or underpayments, and coordinate with clinical staff or management to gather necessary documentation. Effective communication and cross-functional teamwork are essential, as Payor Analysts frequently participate in meetings to discuss trends, escalate complex cases, and implement process improvements that benefit the entire organization.

What is a payor analyst job description?

A payor analyst is responsible for managing and analyzing insurance claims, reimbursement processes, and payer contracts to ensure accurate billing and payment. They often use healthcare data systems and require knowledge of insurance policies, coding, and compliance standards to optimize revenue cycle management.
What are popular job titles related to Payor Analyst jobs in Wisconsin? For Payor Analyst jobs in Wisconsin, the most frequently searched job titles are:
What job categories do people searching Payor Analyst jobs in Wisconsin look for? The top searched job categories for Payor Analyst jobs in Wisconsin are:
What cities in Wisconsin are hiring for Payor Analyst jobs? Cities in Wisconsin with the most Payor Analyst job openings:
Payor Analyst jobs near you
Infographic showing various Payor Analyst job openings in Wisconsin as of August 2026, with employment types broken down into 1% Internship, 83% Full Time, 10% Part Time, and 6% Contract. Highlights an 81% Physical, 9% Hybrid, and 10% Remote job distribution.

Coding and Compliance Analyst

Family Health Center

Marshfield, WI • On-site

Full-time

Re-posted 2 days ago

Job description

JOB SUMMARY

The Coding and Billing Compliance Analyst plays a critical role in safeguarding the accuracy, integrity, and regulatory compliance of coding and billing operations across all service lines. This position supports the organization’s revenue cycle and compliance initiatives by conducting detailed coding and billing reviews, identifying areas of risk, and contributing to the development of corrective action plans and educational programs. The analyst ensures adherence to federal and state billing regulations, including Medicaid/Medicare guidelines, HRSA program requirements, and Office of Inspector General (OIG) guidance specific to Federally Qualified Health Centers (FQHCs). The Analyst collaborates with providers, billing teams, compliance officers, and revenue cycle leadership, to improve clinical documentation, optimize reimbursement, and maintain full compliance with all applicable standards and payer requirements.

ESSENTIAL JOB FUNCTIONS

  1. Reviews provider documentation, medical records, and associated charges to ensure correct assignment of ICD-10, CPT, HCPCS codes, and modifiers according to payer, CMS, HRSA, and FQHC-specific guidelines.
  2. Conducts regular audits of coding, billing, and claims to ensure accuracy, completeness, and compliance with CPT, CDT, HCPCS, ICD-10, and payer-specific guidelines.
  3. Monitors claims submissions, pre-bill edits, denials, and payor feedback and identify coding and billing errors or trends and recommend corrective actions and coordinate follow-up audits as needed.
  4. Assists in developing, updating, and maintaining coding and billing compliance policies, procedures, training materials as guidelines or payor rules change.
  5. Collaborates proactively with providers, clinical teams, and billing staff to ensure accurate documentation, compliant coding practices, and adherence to Medicaid coverage and reimbursement requirements.
  6. Analyzes denied or underpaid claims to identify root causes, including coding errors, documentation gaps, or payer-specific policy issues, and collaborate with interdepartmental teams to implement targeted process improvements that strengthen billing compliance and optimize revenue integrity.
  7. Monitors and interprets payer updates, coding changes, and reimbursement policy revisions from CMS, HRSA, Medicaid, and commercial payers; evaluates their impact on FQHC operations and communicates relevant updates, guidance, and action steps to affected departments to ensure compliance and optimized reimbursement.
  8. Monitors coding practices for compliance with FQHC Prospective Payment System (PPS) and encounter-based billing guidelines.
  9. Performs charge reviews comparing itemized bills to medical record documents to ensure appropriate charges.
  10. Conducts regular staff training sessions for providers, billers, and clinical staff on documentation, coding updates, and compliance best practices.
  11. Prepares audit reports and presents findings to leadership and compliance officer.
  12. Maintains strict adherence to scheduled work hours with regular and reliable attendance.
  13. Performs other duties as assigned.

EDUCATION AND EXPERIENCE

  1. Minimum of 3-5 years of experience in medical billing, coding, and/or compliance within a healthcare setting is required; FQHC experience preferred.
  2. Proficiency with EHR and practice management systems (e.g., Epic Systems, NextGen Healthcare, eClinicalWorks).
  3. Associate’s or degree in Health Information Management, Healthcare Administration, or related field preferred.

CERTIFICATIONS / LICENSES

  1. Certified Professional Coder (CPC), awarded by American Academy Professional Coders (AAPC) required.
  2. Additional credentials such as Certified Compliance Professional (CCP) preferred.
  3. Valid Wisconsin Driver’s License required with an acceptable motor vehicle record (MVR), per FHC guidelines.


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