Payer Strategy Specialist
Hybrid · Nashville, Tennessee, United States
Job Summary
Oversee verification of benefits process to ensure accurate policy reviews and management of referral complexities, enabling accurate patient responsibility assessment and reimbursement. Responsibilities include collecting and analyzing data from payer policies, reimbursement trends, market access, and formularies; monitoring payer trends; supporting cross-functional development of market access strategies; preparing reports and presentations for senior leadership; tracking payer performance metrics; maintaining databases/tools for payer access and reimbursement status; and providing recommendations on payer strategy adjustments based on evolving market conditions.
Required Qualifications
- 1-3 years of experience in the healthcare industry (patient account representative, insurance collections, payer strategy, market access, healthcare consulting, or a similar field)
- Strong understanding of payer dynamics, including reimbursement, formulary management, and market access strategies
- Proficient in data analysis and reporting, with the ability to synthesize complex information into clear, actionable insights and trending patterns
- Knowledge of government programs such as Medicaid and commercial payer structures
- Proficiency in Microsoft Office Suite (Excel, PowerPoint, Word); experience with data analysis tools or CRM software is a plus
- Excellent written and verbal communication skills, with the ability to communicate complex ideas to both technical and non-technical audiences
- Strong organizational skills and ability to manage multiple projects and priorities simultaneously
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