Payer Analytics Specialist
Department:Patient Accounts / Revenue Cycle
Full Time/PRN:Full Time, Monday-Friday
Job SummaryThe Payer Analytics Specialist reports to the Patient Accounts Director and provides reporting and analysis related to payer reimbursement trends, denials, and revenue cycle performance. This role supports data-driven decision-making through detailed payer analysis, trend identification, and collaboration with revenue cycle stakeholders to improve reimbursement outcomes.
Essential Duties & ResponsibilitiesResearch and analyze insurance claim denials, ADR requests, recoupments, and underpayments; Utilize EMR and clearinghouse analytics tools; Identify trends and provide monthly and quarterly reports; Collaborate with admissions, billing, coding, administration, and provider liaisons; Submit and track appeals; Respond to payer and RAC audit requests; Maintain payer reference materials; Assist with special projects and complex billing issues; Maintain current knowledge of government and commercial payors; Track denial trends, perform root cause analysis, and recommend process improvements.
Education & ExperienceHigh school diploma or GED required; Associate’s or Bachelor’s degree preferred; One year experience in hospital or professional billing, medical coding, or healthcare registration preferred; Ability to type at least 30 WPM; Demonstrated verbal and written communication skills.
Minimum QualificationsKnowledge of insurance billing procedures and medical terminology; Strong attention to detail; Ability to manage multiple tasks; Proficiency in Microsoft Office; Experience with billing software preferred; Strong organizational and time-management skills; Ability to maintain confidentiality and comply with HIPAA; Knowledge of ICD-10, CPT/HCPCS, medical necessity guidelines; Strong analytical and problem-solving skills; Ability to interpret payer policies and contractual language.
All candidates must be able to perform the essential functions of this position. The American with Disabilities Act (ADA) requires that reasonable accommodations be made for qualified individuals to help perform the essential functions of the position.
South Central Regional Medical Center is an equal opportunity employer and does not discriminate based on race, color, religion, sex, gender, national origin, age, disability, or genetic information.
Skills Required
- High school diploma or GED
- One year experience in billing, coding, or healthcare registration
- Knowledge of insurance billing procedures and medical terminology
- Ability to type at least 30 WPM
- Proficiency in Microsoft Office
What We Do
South Central Regional Medical Center is a 285-bed, public not-for-profit hospital located in Laurel, MS founded in 1952. The hospital primarily serves a 4-county area: Jones County, Jasper County, Wayne County and Smith County. The primary focus of the South Central Regional Medical Center Health System is to provide excellent healthcare services to the residents of South Central Mississippi and to improve the quality of life in the region. With more than 80 physicians on staff representing 28 medical specialties, South Central continues to meet the healthcare needs of a growing region. With over 2,100 employees throughout the health system, the highly skilled healthcare professionals work with cutting-edge technologies and offer the most modern diagnostic and treatment options.
