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FinThrive · 2 months ago

Payer Relations Analyst

United States

Full-time

Remote

Entry, Mid Level

2+ years exp

FinThrive is advancing the healthcare economy, and they are seeking a Payer Relations Analyst to build and manage payer relationships. The role involves coordinating the implementation of payer connections, ensuring compliance with regulatory requirements, and collaborating with development teams to enhance prior authorization processes.

BillingConsultingHealth Care

Responsibilities

Own the process for building payer relationships, identifying payer requirements for connection, translating requirements into user stories for the development team, coordinating implementation and testing, and ensuring the payer connection is successful in production

Fill the role of subject matter expert in relation to prior authorizations and notice of admission both in terms of payer requirements and overall business requirements to successfully manage prior authorizations between providers and payers

Identify and document the correct method of submission and status for prior authorizations to payers based on the payer requirement for specific service or CPT code including EDI 278 215/217, UMO payer portal, or Fax

Document payer portal prior authorization workflows for robotic process automation and work with the RPA development team to build and test new payer portal prior auth automations

Define and monitor key metrics for prior authorization connectivity, including transaction turnaround time, error rates, and customer satisfaction

Maintain up-to-date knowledge of regulatory requirements impacting prior authorization processes and ensure compliance in all payer connections

Become an expert in the upcoming Da Vinci FHIR prior authorization standards and work with development and business teams to ensure successful transition to FHIR

Work with payers and providers to establish FHIR connections for Prior Auth

Collaborate with the development team and clearinghouse team to establish EDI connections to payers

Collaborate closely with development, QA, UX, and other cross-functional teams to ensure deliverables meet customer and business expectations

Engage directly with customers and internal stakeholders to elicit and understand business needs, pain points, and desired outcomes

Triage errors and issues that arise and work and collaborate with other teams to resolve as needed to resolve the issues

Prioritize the payer connection backlog based on business value, customer impact, and development capacity, ensuring alignment with strategic goals

Apply critical thinking to streamline processes and work towards continual improvement and efficiency

Maintain and prioritize the user story backlog and work with development and stakeholder teams to refine user stories to meet the Definition of Ready for development

Work with the scrum team to ensure all tasks are completed and the committed objectives are achieved

Qualification

Healthcare prior authorizationsDa Vinci FHIR standardsEDI transactionsAgile ScrumHealthcare revenue cycle managementAnalytical skillsTraining othersCritical thinkingCommunication skillsInterpersonal skills

Required

Subject matter expert knowledge of healthcare prior authorizations and notice of admission processes on the provider, payer, and UMO sides

2+ years of experience working with prior authorization submissions and status to payers and UMOs

Knowledge of Da Vinci FHIR and ability to become a Da Vinci FHIR subject matter expert

Strong skills in creating detailed requirements, user stories, and acceptance criteria

Strong analytical and critical thinking skills to solve complex business problems

Provide guidance and direction to the technology teams during the development cycle and participate in all scrum ceremonies. Be available and ready to make quick, well-informed team-level decisions on behalf of stakeholders and the business

Ability to train others and share knowledge across teams

Excellent written and verbal communication skills, excellent inter-personal skills with the ability to bridge business and technical environments, and ability to build professional relationships

Ability to quickly learn complex systems and understand product architecture and development frameworks