Specialist, Revenue Cycle Systems

We're a physician-led, patient-centric network committed to simplifying health care and bringing a more connected kind of care.

Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and virtually through VillageMD and our operating companies Village Medical, Village Medical at Home, Summit Health, CityMD, and Starling Physicians.

When you join our team, you become part of a compassionate community of people who work hard every day to make health care better for all. We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure all patients have access to high-quality, connected care services that provide better outcomes at a reduced total cost of care.

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The Payer Knowledge Systems Analyst supports the revenue cycle and managed care teams by ensuring accurate payer contract implementation, monitoring reimbursement performance, and analyzing variances between expected and actual payments. This role is critical in maintaining financial integrity, optimizing reimbursement, and supporting contract negotiation and compliance initiatives within the organization.

Essential Duties & Responsibilities:

• Review and interpret payer and provider agreements, amendments, and fee schedules to ensure accurate setup in the contract management and billing system.
• Maintain a comprehensive database of payer contracts and rate tables, including updates for renewals, policy changes, and regulatory adjustments.
• Collaborate with IT and revenue integrity teams to validate correct loading of contractual terms in revenue cycle systems (e.g., Epic, Athena).
• Perform required maintenance and upkeep of the contract management system, Rivet. Including the building of logic and downstream troubleshooting required when issues are identified.
• Perform detailed variance analysis to identify underpayments, overpayments, and billing discrepancies
• Perform detailed system configuration analysis to identify system issues causing discrepancies within EMR and all downstream systems
• Reconcile expected versus actual reimbursement using contract modeling and payment data
• Support managed care and revenue integrity teams in validating payer performance and identifying opportunities for recovery or renegotiation
• Develop and maintain contract performance dashboards and financial reports for leadership
• Track payer compliance with agreed reimbursement terms, escalation procedures, and payment timelines
• Assist in preparing financial impact assessments for proposed contract changes or new agreements
• Work closely with contracting, billing, coding, and finance teams to ensure alignment between contract terms and revenue cycle operations
• Support contract negotiation and renewal processes with data-driven insights.
• Communicate complex reimbursement and contractual information in a clear, actionable format for operational leaders
• Maintain knowledge of the functional area and company policies and procedures
• Proactively monitor manual processes with the intent to automate and optimize
• Assists management with the execution and compliance with Standard Operating Practices (SOP's) and Plans of Action
• Gathers parameters, perform analysis, implements solutions, and tracks outcomes to ensure accuracy of all transactions
• Organizes transaction flows between internal systems and continuously optimizes manual processes
• Creates reports to monitor data accuracy and statistics. Including review of the EMR systems to ensure proper rates are being used on the claims submitted to carriers for reimbursement
• Tracks the resolution of the process and share knowledge with the team to maximize understanding and effectiveness
• Provides support with documented follow-up as needed on Payer Calls.
• Identifies data and/or conversion issues and proactively reports issues to both internal and external clients
• Maintain excellent relationships with 3rd party vendors
• Additional duties and responsibilities as required and/or assigned

Requirements:

• Associates degree preferred or equivalent experience.
• Ability to work in a fast-paced environment
• Prior experience in a hospital, physician group, or healthcare payer setting.
• Familiarity with government and commercial payer policies.
• Exposure to contract modeling tools or data visualization software (e.g., Power BI, Tableau, Rivet).
• Prior experience with troubleshooting/problem resolution of contract adherence issues.
• In-depth knowledge of HIPAA, 837, 835, 270/271, 276/277, and other healthcare EDI standard formats
• Working knowledge of UB04 and CMS-1500 claim forms
• Working knowledge of ICD-10 and CPT codes
• Detail-oriented & efficiency-minded; good at finding ways to improve processes and operations
• Organized with the ability to design and maintain effective tracking systems
• Must be technically savvy and comfortable using software, including, but not limited to MS Office, Insurance Portals, and Electronic Claims Submissions.
• High aptitude to learn new programs, system integrations, and business processes.
• Takes initiative to resolve situations and to accomplish projects actions and tasks.
• Excellent customer service skills with strong written and verbal communication skills
• Strong work ethic with a proven track record of accuracy, dependability, and consistency
• Must are able to think independently, have strong Analytical, creative problem-solving skills with a continuous improvement mentality.
• Ability to gain the cooperation of others and work in a team environment in pursuit of company goals.
• Excellent organizational skills with the ability to manage multiple tasks and priorities
• Ability to handle confidential & sensitive information
• Professional attitude, demeanor, and work ethic.
• Strong customer relations and interpersonal skills.
• Ability to handle difficult situations tactfully and diplomatically solving problems.

This position is an exempt role. The salary range for this role is $62,000 - $79,000.

Our team members are essential to our mission to reshape healthcare through the power of connection. VillageMD highly values the critical role that health and wellness play in the lives of our team members and their families. Participation in VillageMD's benefit platform includes Medical, Dental, Life, Disability, Vision, FSA coverages and a 401k savings plan.

Our Company provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to, and does not discriminate on the basis of, race, color, religion, creed, gender/sex, sexual orientation, gender identity and expression (including transgender status), national origin, ancestry, citizenship status, age, disability, genetic information, marital status, pregnancy, military status, veteran status, or any other characteristic protected by applicable federal, state, and local laws.

Our Company cares about the safety of our employees and applicants. Our Company does not use chat rooms for job searches or communications. Our Company will never request personal information via informal chat platforms or unsecure email. Our Company will never ask for money or an exchange of money, banking or other personal information prior to the in-person interview. Be aware of potential scams while job seeking. Interviews are conducted at select Our Company locations during regular business hours only. For information on job scams, visit, or file a complaint