Payer Integration Solutions Analyst

Essential Job Duties

Gather, analyze, validate, and document customer, payer, business, and technical requirements, and translate payer specifications and companion guides into scalable configurations and integration solutions.
Independently own assigned payer integration and configuration work from requirements definition through testing, validation, and production readiness.
Configure and maintain payer-specific billing rules, claim submission logic, enrollment requirements, reimbursement workflows, and related system integrations.
Analyze and troubleshoot implementation and production issues; identify root causes; evaluate alternatives; and recommend and implement appropriate corrective actions within the role's scope.
Partner with Implementation, Product, Engineering, Operations, payer, and client-facing teams, and support Senior Solution Analysts on complex requirements, escalations, and broader implementation efforts.
Execute testing, validation, and quality assurance activities to confirm configurations and integrations meet documented requirements and expected outcomes.
Support payer onboarding, production-readiness activities, enhancement requests, and ongoing optimization of payer configurations and integrations.
Monitor and maintain payer configurations and integrations to support performance, accuracy, and compliance with payer requirements.
Create and maintain requirements, configuration decisions, test results, operating procedures, internal tools, training materials, and best-practice documentation, and provide knowledge transfer.
Serve as a resource who bridges technical, operational, payer, and customer requirements while meeting service-level agreements, delivery standards, and internal procedures.

Other Job Duties

Other duties as assigned by supervisor or HHAeXchange leader.

Travel Requirements

• Travel up to 10%, including overnight travel

Required Education, Experience, Certifications and Skills

Four or more years of relevant experience in healthcare revenue cycle, payer operations, claims processing, healthcare technology, healthcare data integration, or healthcare software implementation.
Working knowledge of Medicaid and managed care organization revenue cycle and payer processes, including claim submission, payer responses, reimbursement, rejections, and denials.
Working knowledge of healthcare electronic data interchange and X12 standards, including 837, 835, 270/271, and 276/277 transactions.
Experience interpreting payer specifications, companion guides, implementation requirements, and data elements; documenting business and technical requirements; and translating them into configuration or integration requirements.
Experience working with configuration-driven software platforms and managing multiple implementation or configuration activities through completion.
Strong analytical and troubleshooting skills, including the ability to identify root causes, evaluate alternatives, and determine appropriate next steps.
Knowledge of common healthcare integration methods and technologies, including secure file transfer protocol and application programming interfaces.
Strong written and verbal communication, organization, attention to detail, and the ability to ask effective discovery questions, challenge assumptions constructively, make recommendations, prioritize work, and collaborate across functions.
Experience with work-management and documentation tools such as Jira, Salesforce, Confluence, or SharePoint, and the ability to independently own assigned responsibilities within a cross-functional delivery model.
Ability to work on-site three days per week in the New York, Miami, or Bloomington office, with in-office requirements subject to change based on business needs.
Preferred experience includes home care or home care technology, healthcare software as a service, Health Level Seven or Fast Healthcare Interoperability Resources standards, or work with state Medicaid agencies, home care providers, or clearinghouses.
Willingness to explore and adopt AI tools responsibly to enhance productivity and innovation in your role.