Southwestern Health Resources CIN
Payor Analyst - Southwestern Health Resources
Southwestern Health Resources CIN, Pittston, Pennsylvania, United States
Payor Analyst
Market Relations Department is looking for a top skilled Payor Analyst. Work location:
Hybrid: Southwestern Health Resources Headquarters, 1601/1603 Lyndon B. Johnson Freeway, Farmers Branch, TX 75234. Work environment:
Market Relations Work hours: Full-time, 40 hours per week. Monday - Friday, Day shift. This is a Hybrid position, to be based in North Texas/Dallas-Fort Worth area, requiring occasional onsite workdays, based on department business needs. In-person attendance required at department meetings, trainings and/or other department authorized activities, at the above-mentioned address or other locations as directed by the department management. About SWHR At Southwestern Health Resources (SWHR), we believe healthcare can be more integrated, accessible, and affordable for all. Our purpose is simple yet powerful: to build a better way to care, together. SWHR is a patient-centered, clinically integrated network that brings together academic and community clinicians, researchers, hospitals, and ambulatory facilities. We partner with physicians to drive a new model of value-based, high-quality, data-driven healthcare—serving everyone in the communities we touch. By combining the strengths of UT Southwestern Medical Center and Texas Health Resources, we\'ve built the largest provider network in North Texas, giving our team members the opportunity to make a meaningful impact at scale. Healthcare in the U.S. is evolving rapidly, and SWHR is committed to leading that change—moving healthcare forward, together. What You Will Do
Assists the Managed Care Director with the following: Contract management support:
Review and interpret payor contracts to understand contract language, reimbursement rates, billing rules and other relevant items of the contract. Assist with maintaining contract language key terms by payor tracking grid. Prepare routing documents for new contracts and amendments. Review and redline low-level amendments (e.g., term extensions, facility listing updates) and regulatory exhibits (Texas, Medicare, Medicaid). Complete and distribute New Contract Orientation forms and communications to internal stakeholders. Maintain organized records of contract status, amendments, and stakeholder communications.
Time allocation: 35% Claims Project management:
Maintain claim project tracker by payor (e.g., Aetna, BCBSTX, Cigna, UHC) and monitor project status. Participate in payor claim calls, identify claim trends, work with payors to resolve issues and document outcomes. Escalate unresolved claims to appropriate parties and follow through to resolution. Maintain and update claim project trackers, ensuring alignment with internal stakeholders and timelines.
Time allocation: 20% Payor Policy & Procedure Update management:
Interpret and communicate payor policy changes to internal stakeholders, ensuring compliance and accurate billing practices. Review daily updates from Policy Reporter to identify changes with potential financial impact. Collaborate with analysts to assess the financial implications of policy changes for internal stakeholders. Notify payors of significant impacts within required timeframes and monitor resolution status. Document and communicate policy changes and outcomes to relevant internal teams.
Time allocation: 10% Managed Care Projects/Payor Queries:
Support cross-functional managed care initiatives and respond to payor-related queries. Communicate with payors, internal stakeholders (billing, coding, clinical), and others to resolve issues and improve processes. Collect, organize, and present data in a clear and actionable format. Provide timely updates and final reports to requesting departments or leadership. Ensure all project documentation is complete, accurate, and accessible.
Time allocation: 30% Committee Participation:
Represent the Managed Care team in internal and external meetings, committees, and workgroups. Actively participate in discussions, share insights, and contribute to strategic planning efforts. Build and maintain strong relationships with payors and internal departments to support collaborative problem-solving.
Time allocation: 10% Education
Bachelor\'s Degree in Business or Healthcare (4 years required) or Master\'s Degree in Business or Healthcare (preferred). Experience
4 years of experience in managed care, payor relations, or healthcare operations (required). Skills
Familiarity with healthcare payor systems and contract language. Experience with policy impact analysis and claims resolution. Ability to work independently and collaboratively in a fast-paced environment. Excellent project management and problem-solving skills. Detail-oriented. Strong analytical skills. Excellent oral and written communication skills. Supervision
Individual Contributor Budget Responsibility
Primary Budget Responsibility Less than $100 Thousand: $80k - 110K ADA Requirements
Working Indoors 67% or more Physical Demands
Sedentary
#J-18808-Ljbffr
Market Relations Department is looking for a top skilled Payor Analyst. Work location:
Hybrid: Southwestern Health Resources Headquarters, 1601/1603 Lyndon B. Johnson Freeway, Farmers Branch, TX 75234. Work environment:
Market Relations Work hours: Full-time, 40 hours per week. Monday - Friday, Day shift. This is a Hybrid position, to be based in North Texas/Dallas-Fort Worth area, requiring occasional onsite workdays, based on department business needs. In-person attendance required at department meetings, trainings and/or other department authorized activities, at the above-mentioned address or other locations as directed by the department management. About SWHR At Southwestern Health Resources (SWHR), we believe healthcare can be more integrated, accessible, and affordable for all. Our purpose is simple yet powerful: to build a better way to care, together. SWHR is a patient-centered, clinically integrated network that brings together academic and community clinicians, researchers, hospitals, and ambulatory facilities. We partner with physicians to drive a new model of value-based, high-quality, data-driven healthcare—serving everyone in the communities we touch. By combining the strengths of UT Southwestern Medical Center and Texas Health Resources, we\'ve built the largest provider network in North Texas, giving our team members the opportunity to make a meaningful impact at scale. Healthcare in the U.S. is evolving rapidly, and SWHR is committed to leading that change—moving healthcare forward, together. What You Will Do
Assists the Managed Care Director with the following: Contract management support:
Review and interpret payor contracts to understand contract language, reimbursement rates, billing rules and other relevant items of the contract. Assist with maintaining contract language key terms by payor tracking grid. Prepare routing documents for new contracts and amendments. Review and redline low-level amendments (e.g., term extensions, facility listing updates) and regulatory exhibits (Texas, Medicare, Medicaid). Complete and distribute New Contract Orientation forms and communications to internal stakeholders. Maintain organized records of contract status, amendments, and stakeholder communications.
Time allocation: 35% Claims Project management:
Maintain claim project tracker by payor (e.g., Aetna, BCBSTX, Cigna, UHC) and monitor project status. Participate in payor claim calls, identify claim trends, work with payors to resolve issues and document outcomes. Escalate unresolved claims to appropriate parties and follow through to resolution. Maintain and update claim project trackers, ensuring alignment with internal stakeholders and timelines.
Time allocation: 20% Payor Policy & Procedure Update management:
Interpret and communicate payor policy changes to internal stakeholders, ensuring compliance and accurate billing practices. Review daily updates from Policy Reporter to identify changes with potential financial impact. Collaborate with analysts to assess the financial implications of policy changes for internal stakeholders. Notify payors of significant impacts within required timeframes and monitor resolution status. Document and communicate policy changes and outcomes to relevant internal teams.
Time allocation: 10% Managed Care Projects/Payor Queries:
Support cross-functional managed care initiatives and respond to payor-related queries. Communicate with payors, internal stakeholders (billing, coding, clinical), and others to resolve issues and improve processes. Collect, organize, and present data in a clear and actionable format. Provide timely updates and final reports to requesting departments or leadership. Ensure all project documentation is complete, accurate, and accessible.
Time allocation: 30% Committee Participation:
Represent the Managed Care team in internal and external meetings, committees, and workgroups. Actively participate in discussions, share insights, and contribute to strategic planning efforts. Build and maintain strong relationships with payors and internal departments to support collaborative problem-solving.
Time allocation: 10% Education
Bachelor\'s Degree in Business or Healthcare (4 years required) or Master\'s Degree in Business or Healthcare (preferred). Experience
4 years of experience in managed care, payor relations, or healthcare operations (required). Skills
Familiarity with healthcare payor systems and contract language. Experience with policy impact analysis and claims resolution. Ability to work independently and collaboratively in a fast-paced environment. Excellent project management and problem-solving skills. Detail-oriented. Strong analytical skills. Excellent oral and written communication skills. Supervision
Individual Contributor Budget Responsibility
Primary Budget Responsibility Less than $100 Thousand: $80k - 110K ADA Requirements
Working Indoors 67% or more Physical Demands
Sedentary
#J-18808-Ljbffr