Payor Reimbursement & Claims Remediation Specialist

The role

The Payor Reimbursement & Claims Remediation Analyst analyzes payor payment performance and resolves systemic claims issues. This individual contributor role uses Power BI to identify payment variances and leads remediation efforts to recover underpayments.

What you will do

• Run Power BI reports to analyze payor payment performance.
• Analyze payor adherence to contracted fee schedules.
• Identify patterns of incorrect payment and quantify financial impact.
• Create reporting packages and data files for payor remediation projects.
• Lead remediation efforts to resolve underpayments and recurring denials.
• Coordinate retrospective claims reprocessing and repayment.
• Serve as the primary operational liaison between payor claims and internal teams.
• Communicate directly with payor operational leaders to drive resolution.
• Partner with billing, credentialing, and FP&A teams.
• Provide data and analysis to the Revenue Cycle Director.

Required qualifications

• Minimum of 5 years of experience in Revenue Cycle Management, payor operations, claims analysis, or related healthcare reimbursement roles.
• Demonstrated experience analyzing reimbursement and payment data.
• Working experience using Power BI or a comparable business intelligence tool.
• Knowledge of claims adjudication and reimbursement methodologies.
• Knowledge of contracted fee schedules, payor contract terms, and expected reimbursement modeling.
• Knowledge of payor policies, payment logic, and operational workflows.
• Knowledge of credentialing and enrollment impacts on claims processing.
• Knowledge of CPT, HCPCS, and ICD-10 coding concepts.
• Knowledge of Explanation of Benefits (EOBs) and payor remittance processes.
• Strong analytical and problem-solving skills.
• Solid working proficiency in Power BI.
• High school diploma or equivalent.

Nice to have

• Bachelor's degree in healthcare administration, business, finance, data analytics, or a related field

Benefits

• health insurance
• dental insurance
• vision insurance
• disability insurance
• life insurance

About the company

Optima Dermatology is a growing multi-site dermatology group with a mission to revolutionize skin care. They foster a collaborative, mission-driven, and hardworking environment.