Payer Strategy & Analytics Senior

Job Posting Closing Date: Open until Filled

Where do you belong?

Your career is more than just a job, it's part of your life. Whether you’re a clinician, or non-clinical professional,  at USACS you'll feel a sense of connection working with clinicians and office staff who share your interests and values. We want you to love coming to work each day because you believe in what you do and the people with whom you work. We care about your success.

USACS also understands that location is important. We offer  career opportunities for clinicians and non-clinical support staff from New York to Hawaii and numerous points in between. Our supportive culture,  outstanding benefits and competitive compensation package is best in class.

Job Description

GENERAL SUMMARY: The Payer Strategy & Analytics Senior Finance Manager is the organization’s analytical lead for payor contracting, out-of-network reimbursement, and the arbitration and litigation processes used to resolve payment disputes. The role provides financial tracking and data-driven decision support to scale out-of-network reimbursement through No Surprises Act (NSA) Independent Dispute Resolution (IDR), state arbitration, and litigation, and to optimize payor contract outcomes. Using CMS IDR Public Use Files and the group’s own arbitration data, the role provides decision support on IDR entity (IDRE) selection, offer and rate strategy, and AR follow-up to optimize reimbursement yield. As a reimbursement subject matter expert, the incumbent develops financial models and partners closely with Finance, Accounting, Legal, and Revenue Cycle leadership to ensure revenue projections and action plans are defensible and well understood.

Location: Remote

ESSENTIAL JOB FUNCTIONS:

• Serves as the key analytical partner to Payor Contracting, Revenue Cycle/AR Follow-Up, Legal, Finance, Accounting, and Operations on in-network and out-of-network reimbursement strategy

• Builds financial models and recommendations to support payor contract negotiations, renewals, and terminations, including quantifying the impact of in-network versus out-of-network scenarios by payor and market

• Ensures revenue recognition, budgets and forecasts are reflective of expected outcomes from IDR, arbitration, and litigation, in accordance with the Company’s revenue recognition policy.

• Owns the analytics supporting out-of-network reimbursement through the federal No Surprises Act IDR process and state arbitration programs; tracking volume, eligibility, filing deadlines, cycle time, win/loss rates, award amounts, and return on dispute cost

• Analyzes the CMS federal IDR Public Use Files and the group’s own IDR determination data to benchmark prevailing-party rates, offers versus awards, and award-to-QPA ratios by payor, service, geography, and IDRE

• Evaluates IDRE selection and determination patterns (fees, timeliness, and outcomes) and recommends selection and objection strategies

• Develops and refines offer and rate strategies for IDR and arbitration submissions, including recommended offer amounts by service, payor, and market

• Analyzes, tracks, and reports on payor contract performance; including yield per encounter, rate benchmarking (e.g., to Medicare, QPA, and commercial benchmarks), rate escalators, and underpayments

• Partners with AR Follow-Up and Revenue Cycle leaders to prioritize work queues, optimize open negotiation and IDR initiation timing, monitor payor compliance with payment of awards, and identify process improvements that increase yield

• Provides data analysis, underpayment and damages modeling, and exhibits in support of payor litigation and award enforcement, working closely with Legal and outside counsel

• Monitors and interprets regulatory, legal, and industry developments (e.g., CMS rulemaking, court decisions, state law changes, and payor behavior) and communicates the potential impact to business leaders

• Performs diligence revenue review of potential payor contracts and acquisitions, including out-of-network exposure and dispute history

• Designs and maintains dashboards, internal performance metrics, and ad-hoc analyses, and presents insights and recommendations to business leaders in clear, actionable terms

• Develops and implements analytics and data collection standards and processes to ensure the integrity of dispute, claims, and contract data

• Other duties as needed

KNOWLEDGE, SKILLS AND ABILITIES:

• Working knowledge of the No Surprises Act, the federal IDR process, the qualifying payment amount (QPA), and state surprise billing and arbitration frameworks

• Demonstrated ability to analyze large public and proprietary data sets (such as the CMS IDR Public Use Files) and translate findings into clear strategy recommendations

• Strong understanding of payor contracting, fee schedules, claims adjudication, remittance and EOB data, and emergency medicine professional billing and coding

• Strong financial acumen and advanced analytical skills, including benchmarking, forecasting, and scenario and sensitivity modeling

• Advanced Excel, PowerPivot and a business intelligence tool (e.g., Power BI or Tableau); experience with SQL, Python, or R preferred

• Strong business acumen and interpersonal skills

• Excellent oral and written communication and presentation skills, including the ability to explain complex data to executives, attorneys, and non-technical partners

• Sound judgment in handling confidential, privileged, and protected health information

• Independently driven, with the ability to manage complex projects and achieve department goals

• Superior time management, organizational, and problem-solving skills

EDUCATION AND EXPERIENCE:

• Bachelor’s degree in Business, Finance/Accounting, Economics, Health Policy, Informatics, or a related field, or equivalent experience (MBA or master’s preferred).

• At least 5 years of reporting, analytics, and business operations experience, preferably in the healthcare/provider space.

• At least 2 years of direct experience in payor contracting analytics, out-of-network reimbursement, or No Surprises Act IDR/state arbitration analytics.

• At least 2-3 years of leadership experience.

• Preferred: experience with emergency medicine or other hospital-based physician groups, and experience supporting litigation or arbitration with Legal and outside counsel.

PHYSICAL DEMANDS:

• While performing the duties of this job, the employee is regularly required to sit for prolonged periods and occasionally walk, stand, bend, stoop, and lift up to 15 pounds.

• Required to have close visual acuity to perform the job.

Salary Range: $103,887-$192,190

Salary Range:

$103,887.00 - $192,191.00

Salary may be determined on several factors including but not limited to knowledge, skills, experience, education, geographical location and requirements stated in job description.

USACS offers a comprehensive and competitive benefits package designed to support the health, well-being, and financial security of our employees.

Benefits may vary based on role, location, and employment status, but generally include:

• Medical, dental, and vision insurance options

• Health savings accounts (HSA) and flexible spending accounts (FSA)

• 401(k) employee and employer contributions

• Paid time off, including vacation, sick leave, and company holidays

• Paid parental leave & family support benefits

• Short-term and long-term disability insurance

• Life and accidental death & dismemberment (AD&D) insurance

• Employee assistance programs & wellness resources

Additional compensation may include bonus eligibility, equity, or other incentive programs, depending on the role.

Specific benefit offerings and eligibility will be provided during the hiring process and may be subject to change in accordance with applicable laws and company policies.

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