[Remote] Payer Strategy & Analytics Senior Finance Manager

Note: The job is a remote job and is open to candidates in USA. US Acute Care Solutions (USACS) is seeking a Payer Strategy & Analytics Senior Finance Manager to lead analytics for payor contracting, out-of-network reimbursement, and payment-dispute resolution. The role develops financial models, tracks arbitration and litigation outcomes, and partners with Finance, Legal, and Revenue Cycle leaders to guide reimbursement strategy and revenue forecasts.

Responsibilities

• 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

Skills

• 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)
• 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
• Bachelor's degree in Business, Finance/Accounting, Economics, Health Policy, Informatics, or a related field, or equivalent experience
• At least 5 years of reporting, analytics, and business operations experience
• 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
• Experience with SQL, Python, or R
• MBA or master's
• Preferably in the healthcare/provider space
• Experience with emergency medicine or other hospital-based physician groups, and experience supporting litigation or arbitration with Legal and outside counsel

Benefits

• Remote work
• 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
• Bonus eligibility, equity, or other incentive programs may be available depending on the role

Company Overview