Resolute Jobs in Tennessee (NOW HIRING)

BASIC PURPOSE OF THE JOB

The Payer Contract and Reimbursement Analyst supports payer strategy, contract management, reimbursement analysis, and operational issue resolution across hospital, physician, ancillary, and specialty service lines. This role blends contract analytics, Epic contract management support, fee schedule maintenance, denial and underpayment analysis, and reporting functions to improve reimbursement accuracy, strengthen payer performance, and support organizational revenue goals. The position serves as a key liaison among payer relations, revenue cycle, business analytics, operational leaders, and managed care organizations.

Requires a strong combination of analytical, communication, and leadership skills, along with a thorough understanding of healthcare operations and managed care principles from both the payer and provider perspectives.

CONTACTS

• Supervisory Responsibilities - No
• Number of Direct Reports - 0
• Number of Indirect Reports - 0
• Population Specific Competencies - NONE
  • Revenue cycle, business office, and patient accounting teams
  • Business analytics and finance staff
  • Credentialing and enrollment staff
  • Practice administrators and operational leadership
  • Hospital and service line leadership

Internal Contacts

• Revenue cycle, business office, and patient accounting teams
• Business analytics and finance staff
• Credentialing and enrollment staff
• Practice administrators and operational leadership
• Hospital and service line leadership

External Contacts

• Managed care organizations and health plan representatives
• Payer contracting, provider relations, reimbursement and claims personnel
• Vendor and network representatives
• External agencies, as applicable

JOB REQUIREMENTS

• Minimum Education
  • Bachelor's degree in business, finance, healthcare administration, or a related field preferred.
• Minimum Work Experience
  • Three years of healthcare, managed care, payer contracting, revenue cycle, healthcare analytics, or related experience required.
• Required Licenses/Certifications for position
  • Epic Resolute Hospital Billing and/or Professional Billing Expected Reimbursement Contract certification preferred or ability to obtain within a defined onboarding period.
• Required Skills, Knowledge, and Abilities
  • Strong knowledge of managed care contracting, payer reimbursement methodologies, and payer-provider operations.
  • Working knowledge of hospital, professional, and ancillary fee schedules and reimbursement terminology, including CPT, HCPCS, DRG, APC, revenue codes, and claim denial workflows.
  • Understanding of payer rules, provider manuals, and regulatory updates affecting reimbursement and contract performance.
  • Ability to interpret contract language and translate reimbursement methodologies into operational and analytical workflows.
  • Experience with Epic contract management, expected reimbursement tools, or comparable contract modeling systems.
  • Ability to mine and manipulate data from multiple systems while ensuring integrity and accuracy.
  • Advanced Excel skills, including complex formulas, modeling, reconciliations, and reporting tools.
  • Strong analytical, critical thinking, and problem-solving skills.
  • Excellent written, verbal, and interpersonal communication skills.
  • Ability to manage multiple priorities, work independently, and collaborate effectively across departments.
  • Strong attention to detail, sound judgment, and timely responsiveness in a fast-paced environment.

PHYSICAL REQUIREMENTS

• Light lifting, pushing, and pulling is required for 10-20 lbs. Occasional and frequent moving of objects of less than 10 lbs. is required. Frequent sitting with some walking, standing, squatting, bending, and reaching is required. Keyboard/computer/scanner/copier/printer use and/or repetitive motions may be required.

MENTAL AND EMOTIONAL REQUIREMENTS

• Demonstrates independent discretion and sound decision-making ability.
• Manages stress appropriately.
• Works effectively both independently and with others.
• Maintains confidentiality and professionalism in sensitive situations.
• Handles multiple priorities effectively.

Essential Functions

• Support negotiation of payer agreements across hospital, physician, behavioral health, home health, surgery center, and other applicable service lines by providing analysis, modeling, and contract interpretation to leaders responsible for negotiations.
• Interpret payer contract terms, payment methodologies, and reimbursement logic, and translate contract language into clear operational and analytical workflows to ensure accurate implementation and compliance.
• Build, configure, test, and maintain payer contract structures and expected reimbursement logic within Epic Contract Management (Hospital and Professional Billing) or related systems, ensuring accurate reimbursement calculations.
• Maintain annual contract escalators and fee schedules for hospital, professional, and ancillary providers; ensure timely updates are reflected in all related analyses and shared with internal matrix partners in a timely manner.
• Perform contract modeling, reimbursement analysis, and payment variance reviews to identify financial risks, underpayments, missed revenue opportunities, and areas for revenue optimization.
• Analyze contract performance by comparing actual payments to expected reimbursement, and research and resolve payer denials, underpayments, bundling issues, and other payment discrepancies.
• Conduct ongoing payer monitoring, including review of payer newsletters, provider manuals, bulletins, and regulatory communications, and communicate operational impacts and required follow-up to stakeholders.
• Partner with revenue cycle, business office, business analytics, credentialing, and operational leaders, as well as payer representatives, to resolve reimbursement and contract-related issues and support joint operating committee activities.
• Provide consultative support to leadership and operational teams by delivering ad hoc analyses, insights on payer performance, denial trends, reimbursement changes, and financial improvement opportunities.

Come work where you can make a difference everyday.