Payer Strategy & Analytics Senior Finance Manager

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Open until Filled Where do you belong?

Your career is more than just a job, it's part of your life. Whether you’re a clinician, or non-clinical professional, at USACS you'll feel a sense of connection working with clinicians and office staff who share your interests and values. We want you to love coming to work each day because you believe in what you do and the people with whom you work.

We care about your success.

USACS also understands that location is important. We offer career opportunities for clinicians and non-clinical support staff from New York to Hawaii and numerous points in between. Our supportive culture, outstanding benefits and competitive compensation package is best in class.

Job Description GENERAL

SUMMARY:

The Payer Strategy & Analytics Senior Finance Manager is the organization’s analytical lead for payor contracting, out-of-network reimbursement, and the arbitration and litigation processes used to resolve payment disputes. The role provides financial tracking and data-driven decision support to scale out-of-network reimbursement through No Surprises Act (NSA) Independent Dispute Resolution (IDR), state arbitration, and litigation, and to optimize payor contract outcomes.

Using CMS IDR Public Use Files and the group’s own arbitration data, the role provides decision support on IDR entity (IDRE) selection, offer and rate strategy, and AR follow-up to optimize reimbursement yield. As a reimbursement subject matter expert, the incumbent develops financial models and partners closely with Finance, Accounting, Legal, and Revenue Cycle leadership to ensure revenue projections and action plans are defensible and well understood.

Location:

Remote

ESSENTIAL JOB FUNCTIONS:

Serves as the key analytical partner to Payor Contracting, Revenue Cycle/AR Follow-Up, Legal, Finance, Accounting, and Operations on in-network and out-of-network reimbursement strategy

Builds financial models and recommendations to support payor contract negotiations, renewals, and terminations, including quantifying the impact of in-network versus out-of-network scenarios by payor and market

Ensures revenue recognition, budgets and forecasts are reflective of expected outcomes from IDR, arbitration, and litigation, in accordance with the Company’s revenue recognition policy.

Owns the analytics supporting out-of-network reimbursement through the federal No Surprises Act IDR process and state arbitration programs; tracking volume, eligibility, filing deadlines, cycle time, win/loss rates, award amounts, and return on dispute cost Analyzes the CMS federal IDR Public Use Files and the group’s own IDR determination data to benchmark prevailing-party rates, offers versus awards, and award-to-QPA ratios by payor, service, geography, and IDREEvaluates IDRE selection and determination patterns (fees, timeliness, and outcomes) and recommends selection and objection strategies

Develops and refines offer and rate strategies for IDR and arbitration submissions, including recommended offer amounts by service, payor, and market

Analyzes, tracks, and reports on payor contract performance; including yield per encounter, rate benchmarking (e.g., to Medicare, QPA, and commercial benchmarks), rate escalators, and underpayments

Partners with AR Follow-Up and Revenue Cycle leaders to prioritize work queues, optimize open negotiation and IDR initiation timing, monitor payor compliance with payment of awards, and identify process improvements that increase yield

Provides data analysis, underpayment and damages modeling, and exhibits in support of payor litigation and award enforcement, working closely with Legal and outside counsel

Monitors and interprets regulatory, legal, and industry developments (e.g., CMS…