Position Summary

The Payer Operations Analyst plays a critical role in ensuring the accuracy, efficiency, and integrity of payer-related setup and operations across Thriveworks systems. This provider-side position is responsible for translating payer contracts into precise system configurations, managing fee schedules, maintaining high-quality payer data, and supporting operational readiness across Revenue Cycle, Credentialing, and EHR functions.

The ideal candidate is detail-oriented, proactive, and highly skilled in payer configuration workflows, EHR setup, system QA, and payer portal navigation. This role includes regular collaboration with internal partners and a third‑party billing vendor to ensure flawless execution of payer operations.

Key Responsibilities

Payer Configuration & System Management

• Implement and maintain payer configuration details (payer IDs, claims routing, EDI enrollment details, billing requirements, plan IDs, etc.) across the EHR and related systems.
• Support the loading, updating, and auditing of payer fee schedules based on executed contracts, amendments, or updates from payer portals (e.g., Availity, NaviNet, Change Healthcare).
• Establish and enforce standardized naming conventions for payers, networks, and plans across scheduling tools and EHR systems.

Quality Assurance & Data Integrity

• Partner with the EHR administration team to configure and test payer setups to ensure proper routing for eligibility, claims, and remittance data.
• Conduct ongoing QA audits to validate payer configuration accuracy and maintain high-quality system data.
• Maintain a centralized repository of payer information, including configurations, fee schedules, contact lists, portal credentials, and audit logs.

Vendor & Payer Coordination

• Collaborate closely with a third‑party billing vendor to share configuration updates, resolve claim routing issues, and ensure alignment on QA routines and operational processes.
• Monitor payer portals and communications for updates to policies, fee schedules, and billing guidelines; ensure timely implementation of required changes.
• Conduct outreach to selected payer partners for rate reviews, fee schedule requests, or policy clarifications.

Cross-Functional Collaboration

• Partner with RCM, Credentialing, Finance, Compliance, and operational teams to ensure seamless handoff from contract execution to operational readiness.
• Support internal and external audits by providing accurate and current configuration documentation.

Continuous Improvement

• Identify opportunities to automate payer setup processes, improve data hygiene, enhance efficiency, and streamline documentation.
• Lead or contribute to special projects focused on improving operational infrastructure and payer-related workflows.

Qualifications

Required

• Bachelor’s degree in Healthcare Administration, Business, or related field; or equivalent experience.
• 3–5 years of experience in healthcare payer operations, provider network setup, EHR configuration, or related areas within a provider organization.
• Strong understanding of payer configuration elements: payer IDs, EDI enrollments, claims addresses, plan IDs, reimbursement structures, and fee schedule loading.
• Experience collaborating with third‑party billing vendors or RCM teams.
• Proficiency with payer portals such as Availity, NaviNet, and Change Healthcare.
• Demonstrated attention to detail with proven success in maintaining data integrity and QA processes.
• Strong organizational, communication, and project management skills.

Preferred

• Experience in behavioral health or outpatient healthcare settings.
• Familiarity with AdvancedMD or similar EHR/Practice Management systems.
• Knowledge of payer policies, reimbursement methodologies, and provider enrollment workflows.