Payor Pricing Analyst

Overview:

The Payor Pricing Analyst is a highly analytical role focused on building, maintaining, and optimizing financial models that drive payor contract strategy. This individual will serve as the quantitative engine behind fee schedule negotiations, reimbursement benchmarking, and revenue impact modeling across all contracted and non-contracted payors. The ideal candidate brings advanced modeling expertise and the ability to translate complex payor data into clear, actionable negotiation insights.

Responsibilities:

Financial & Reimbursement Modeling

• Build and maintain dynamic fee schedule models across UCR, Medicaid, Medicare Advantage and commercial payor contracts

• Develop multi-scenario revenue impact models to evaluate proposed fee changes and network participation decisions

• Create annual reimbursement benchmarking analyses comparing contracted rates to FAIR Health, ADA fee surveys, and internal production data

Payor Contract Analysis & Negotiation Support

• Prepare negotiation briefs with modeled rate ask scenarios, walk-away thresholds, and estimated uplift

• Track contract lifecycles, renewal timelines, and amendment history across all payor relationships

• Support leadership with data packages for payor meetings, including trend analyses and competitive positioning

• Serve as the primary liaison between Fee Schedule and Payor Pricing teams, ensuring timely and accurate communication of effective dates, fee updates, and new schedule implementations.

Data Infrastructure & Reporting

• Develop ad hoc models for executive decision-making including payor mix optimization and pricing strategy

 

Work Environment:

This job is fully remote with the environment being a home-based professional setting with substantial digital collaboration.

Physical Demands:

The role requires sustained computer and desk work with prolonged sitting, regular virtual communication, and occasional light lifting of typical home-office items.

 

Competencies:

· Financial Analysis & Modeling – Ability to analyze reimbursement data, build financial models, and assess the revenue impact of payor contract changes.

· Payor Reimbursement Expertise – Knowledge of dental insurance reimbursement methodologies, fee schedules, and contract structures.

· Data Analytics – Skilled at interpreting large datasets, identifying trends, and translating findings into actionable business insights.

· Strategic Thinking – Evaluates financial opportunities and risks to support contract negotiations and reimbursement optimization efforts.

· Problem Solving – Investigates reimbursement variances, identifies root causes, and develops effective solutions.

· Communication Skills – Clearly presents complex financial information and collaborates effectively with cross-functional stakeholders.

· Attention to Detail – Ensures accuracy in financial models, fee schedules, contract analysis, and reporting.

· Collaboration – Builds strong partnerships across Revenue Cycle, Finance, Operations, Credentialing, and Leadership teams.

· Business Acumen – Understands how reimbursement strategies impact organizational performance and profitability.

· Continuous Improvement & Accountability – Demonstrates initiative in enhancing processes, reporting, and reimbursement performance while taking ownership of results.

Qualifications:

High School Diploma or Equivalent Required

· 3+ years of experience in dental revenue cycle, payor contracting, or healthcare financial analysis

· Advanced Excel proficiency: financial modeling, pivot tables, VLOOKUP/INDEX-MATCH, scenario analysis, dynamic dashboards

· Experience analyzing fee schedules data at scale

· Demonstrated ability to build models that drive business decisions — not just report data

· Strong written and verbal communication skills; able to present analytical findings to leadership