Payor Reimbursement & Claims Remediation Specialist

The posting, as Optima Dermatology wrote it

Multi-site Dermatology Group Seeks Payor Reimbursement & Claims Remediation Analyst in Portsmouth, NH

Optima Dermatology is recruiting a Payor Reimbursement & Claims Remediation Analyst to join our Practice Support Center, based in Portsmouth, NH.

Location: Hybrid, 111 New Hampshire Ave. Portsmouth, NH 03801

Position Details

The Payor Reimbursement & Claims Remediation Analyst analyzes payor payment performance and resolves systemic payor claims issues that affect reimbursement accuracy and timeliness. The role pairs hands-on data analysis with operational payor remediation. The Analyst uses established Power BI reports to analyze payor adherence to contracted fee schedules, recognizes patterns of incorrect payment, and leads project-level remediation efforts covering underpayments, incorrect claims adjudication, credentialing-related issues, and payor policy misapplication.

This position serves as the primary operational liaison between Optima Dermatology and payor claims, provider operations, contracting, and credentialing teams. The Analyst prepares the reporting and data files that drive payor remediation projects and works closely with Revenue Cycle leadership, FP&A, Accounts Receivable management, billing, and credentialing to recover underpayments, resolve payor issues, and implement forward-looking process improvements. The role provides data and analysis to the Revenue Cycle Director to support decision making. This is an individual contributor role within RCM.

Responsibilities

Payor Fee Schedule Analysis & Payment Integrity

• Run established Power BI reports and use slicers, filters, and standard functions to extract the data needed to analyze payor payment performance.
• Analyze payor adherence to contracted fee schedules by comparing expected reimbursement against actual payment to identify variances.
• Recognize patterns of incorrect payment, including systematic underpayments, fee schedule load errors, bundling and downcoding trends, and policy-driven payment reductions.
• Quantify the financial impact of identified payment issues to prioritize remediation by recovery value and operational urgency.
• Create reporting packages and data files that payors can use to open and process remediation projects, including impacted claim listings, expected versus paid detail, and supporting documentation.

Payor Claims Remediation & Issue Resolution

• Identify and manage systemic, project-level payor issues affecting claims adjudication, payment accuracy, and reimbursement timeliness.
• Lead remediation efforts with payors to resolve underpayments, recurring denials, credentialing-related processing errors, and incorrect policy application.
• Coordinate retrospective claims reprocessing and repayment for impacted claims and accounts.
• Track remediation efforts from identification through resolution, ensuring accountability and follow-through.

Payor Engagement & Liaison

• Serve as the primary operational point of contac

[…]
ently in a complex, fast-paced environment.

Key Competencies

• Demonstrates strong independent initiative, judgment, and accountability.
• Operates effectively as an individual contributor, influencing outcomes through data and collaboration rather than formal authority.
• Interprets payment and fee schedule data, translating analysis into clear findings and recommendations.
• Builds productive working relationships with internal teams and external payor partners.
• Uses data-informed decision making to prioritize payor remediation efforts.
• Communicates complex payor issues clearly to non-technical stakeholders.
• Maintains operational discipline with accurate documentation and tracking.
• Exhibits a continuous improvement mindset, identifying opportunities to prevent recurring payor issues.
• Adheres to all company values, professionalism standards, and HIPAA requirements.

Education

• High school diploma or equivalent required.
• Bachelor's degree in healthcare administration, business, finance, data analytics, or a related field strongly preferred, or an equivalent combination of education and experience.

Compensation

The position will offer competitive compensation. In addition, it will offer the personal reward associated with transforming our patients’ lives and building the most defensible healthcare services platform in the country.

Benefits

Our benefits include generous health, dental, vision, disability, and life insurance.

About Optima Dermatology

At Optima Dermatology, our mission to revolutionize skin care is made possible by our world class team that is highly engaged, mission-driven, and inspired to set the new standard in dermatology. We are growing rapidly and looking for key team members who believe in our mission and want to make a difference in the lives of our patients. We foster a collaborative environment that is fun and hardworking and promise you will work alongside amazing colleagues you are proud to call your teammates.