Payor Analyst – MPR Contracting - Southwestern Health Resources

Payor Analyst – MPR Contracting - Southwestern Health Resources

Southwestern Health Resources is looking for a highly skilled Payor Analyst.  Is that you?

Work Location: Remote: Southwestern Health Resources Headquarters, Hybrid: 1601 Lyndon B. Johnson Freeway, Farmers Branch, TX 75234.

Work Hours: Full Time Days (8:00am-5:00pm) for 40 hrs/week (remote work allowed at manager's discretion)

 Department Highlights:

• Remote Position
• Gain a sense of accomplishment by contributing to a teamwork environment.
• Receive excellent mentorship, comprehensive training, and dedicated leadership resources.
• Contribute and work on a cross functional team

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.
35%
Claims Project management:
Maintain claim project tracker by payor (e.g., Aetna, BCBSTX, Cigna, UHC) and monitor project status.
Participate in payor calls, identify trends, work with payors to resolve issues and document outcomes.
Escalate unresolved issues to appropriate parties and follow through to resolution.
Maintain and update project trackers, ensuring alignment with internal stakeholders and timelines.

20%
Payor Policy & Procedure Update management:
Interpret and communicate contract or contract changes to internal stakeholders.
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 new contract and contract changes and outcomes to relevant internal teams.

10%
Managed Care Projects/Payor Queries:
Support cross-functional managed care initiatives and respond to payor-related queries.
Communicate with providers, payors, internal stakeholders (quality, medical economics, finance), 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.

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.
10%

What You Need: 

Education
Bachelor's Degree Business or Healthcare 4 Years Req Or
Master's Degree Business or Healthcare Pref

Experience
4 Years 4 Years of Experience in managed care, payor relations, or healthcare operations Req