Contracts Payor Analyst

Contracts Payor Analyst

Bring your passion to Texas Health so we are Better Together

Work Location:Texas Health Corporate 612 E. Lamar Blvd. Arlington TX 76011

Work Hours:Full Time Days: (8:00am-5:00pm) for 40 hrs/week (Hybrid work allowed at managers discretion)

Department Highlights:

• Hybrid Position
• Gain a sense of accomplishment by contributing to a teamwork environment.
• Receive excellent mentorship comprehensive training and dedicated leadership resources.

What You Will Do:

Contract Analysis and Audit:

. Validate all payor contract loads ensuring accurate reimbursement methodologies escalator terms carve-outs and fee schedules across EPIC StrataJazz PMMC and related tools.
. Conduct comprehensive contract load audits and identify discrepancies between negotiated terms and system configuration.
. Perform expected-to-actual reimbursement analysis by payor entity service line and claim type.
. Identify and quantify variances; conduct root-cause analysis for underpayments overpayments or contract misinterpretation.
. Partner with Revenue Cycle and Payor Operations to validate underpayment trends and reconcile discrepancies.
. Maintain databases and reporting structures to support continuous monitoring of contract compliance and financial outcomes.
. Ensure data integrity and compliance with regulatory and THR data governance standards.
. Deliver actionable insights by analyzing historical claims data reimbursement trends and competitive market dynamics to inform enterprise pricing strategy for hospitals ancillaries and physicians.
. Prepare dashboards and reports to support executive decision-making including payor performance service line variance analysis reimbursement trends and pricing performance metrics.
. Prepare monthly/quarterly/annual net revenue reports; identify and report on exceptions.
40%
Contract Support and Payor Operations:

. Monitor and report payor performance metrics including reimbursement variance contract yield denial trends and financial impact.
. Track payor policy regulatory updates and operational requirements that affect payment performance or reimbursement calculations.
. Collaborate with Payor Operations Strategic Pricing Revenue Cycle ITS and SWHR to ensure accurate implementation of economic terms and rate changes.
. Support internal audits compliance reviews and pricing validations related to reimbursement accuracy.
. Participate in six-month lookback audits in partnership with Contract Compliance Auditors.
. Provide analytical support for operational issue resolution contract interpretation questions and payor escalations.
. Ensure compliance with industry regulations and Texas Health policies related to payor pricing.
40%
Strategic and Special Projects:

. Support strategic pricing initiatives service-line analysis margin optimization value based care and market competitiveness reviews.
. Build and maintain dashboards visualizing payor performance reimbursement variance and trend analysis for leadership.
. Support modeling for new services alternative payment models bundled arrangements and pricing recommendations.
. Assist with executive-level presentations reporting and strategic planning deliverables.
. Complete additional projects and duties as assigned.
20%
0%

What You Need:

Education
Bachelors Degree Business Finance Accounting Healthcare Administration Data Analytics or related field Req

Experience
3 Years Decision support financial analysis healthcare pricing managed care analytics or revenue cycle to include SQL or relational database experience and/or reimbursement methodologies. Req

Proficiency in Excel Access and SQL Experience with pricing and modeling platforms such as EPIC PMMC Tableau Power BI Power Query Alteryx or other healthcare pricing and claim systems. Preferred

Familiarity with government and commercial payor reimbursement methodologies. Preferred

Knowledge of hospital ancillary and physician coding systems. Preferred

Contract: knowledge experience in loading auditing identifying variances and misrepresentations for hospital and physician providers. Preferred

Education
Bachelors Degree Business Finance Accounting Healthcare Administration Data Analytics or related field Req

Experience
3 Years Decision support financial analysis healthcare pricing managed care analytics or revenue cycle to include SQL or relational database experience and/or reimbursement methodologies. Req

Proficiency in Excel Access and SQL Experience with pricing and modeling platforms such as EPIC PMMC Tableau Power BI Power Query Alteryx or other healthcare pricing and claim systems. Preferred

Familiarity with government and commercial payor reimbursement methodologies. Preferred

Knowledge of hospital ancillary and physician coding systems. Preferred

Contract: knowledge experience in loading auditing identifying variances and misrepresentations for hospital and physician providers. Preferred


Skills
Proficiency in Excel Access and SQL
Experience with pricing and modeling platforms such as EPIC PMMC Tableau Power BI Power Query Alteryx or other healthcare pricing and claim systems is a plus.
Excellent written and verbal communication and strong collaboration skills.
Familiarity with government and commercial payor reimbursement methodologies.
Knowledge of hospital ancillary and physician coding systems.
Strong analytical and problem-solving skills with ability to identify root causes of variance and interpret payor reimbursement methodologies.
Critical thinking skills strong math and computer aptitudes presentation skills.
Ability to manage multiple priorities in a fast-paced environment.

Supervision
Individual Contributor

ADA Requirements
Extreme Heat 1-33%
Extreme Cold 1-33%
Extreme Swings in Temperature 1-33%
Extreme Noise 1-33%
Working Outdoors 1-33%
Working Indoors 1-33%
Mechanical Hazards 1-33%
Electrical Hazards 1-33%
Explosive Hazards 1-33%
Fume/Odor Hazards 1-33%
Dust/Mites Hazards 1-33%
Chemical Hazards 1-33%
Toxic Waste Hazards 1-33%
Radiation Hazards 1-33%
Wet Hazards 1-33%
Heights 1-33%
Other Conditions 1-33%

Physical Demands
Sedentary