Role Description The Payment Compliance & Contract Management (PCCM) Analyst is responsible for maximizing reimbursement by identifying variances between posted and expected revenue for managed care, government contracts, and other payers. This role includes analyzing contract compliance, identifying revenue opportunities, and communicating discrepancies to relevant departments. The PCCM Analyst collaborates with financial and clinical teams to improve revenue cycle processes and optimize payer relationships. - Analyzes contract reimbursement, identifying variances, trends in underpayments/overpayments, denials, and revenue leakage to support maximization of reimbursement. - Manages underpayment appeals and account follow-up, working collaboratively with payers and internal teams to resolve discrepancies in a timely manner. - Interprets contract terms, validates compliance, and provides feedback to management and departments to ensure accurate reimbursement processes. - Compiles, analyzes, and presents data on payment trends, making recommendations for improvements in revenue cycle processes. - Reviews payer policies and updates for their impact on reimbursement, communicating changes to appropriate teams to ensure compliance. - Develops and maintains reports that identify payment discrepancies, revenue opportunities, and performance metrics for management review. - Collaborates with financial, clinical, and operational teams to address contract compliance issues and enhance payer relations. - Maintains knowledge of medical coding systems, reimbursement structures, and regulatory changes to support accurate account adjudication. - Performs other duties as assigned. - Maintains regular and reliable attendance. - Complies with all policies and standards. Qualifications - H.S. Diploma or GED required - Associate Degree or higher preferred - 2-4 years of experience in revenue cycle management, contract compliance, or healthcare reimbursement analysis required Requirements - Strong understanding of managed care, government contracts, and reimbursement processes. - Proficiency in data analysis, with the ability to compile and interpret complex data sets related to contract compliance and payment trends. - Excellent communication and interpersonal skills for working with internal teams and external payer representatives. - Knowledge of medical coding systems (ICD-10, CPT, HCPCS, DRG, etc.) and how they affect claim adjudication. - Strong organizational skills, with the ability to manage multiple projects and deadlines. - Proficient in Google and Microsoft Office Suite, with intermediate to advanced Excel skills.

• Generate high-value analyses from large-scale data related to production, testing, and deployments • Support New Product Introduction (NPI) teams and product operations • Translate complex production and quality concepts into data-driven metrics, intelligent dashboards, and AI-enabled applications • Modernize manual processes into automated, scalable, analytics-driven systems • Identify and implement opportunities to automate manual processes using AI and advanced analytics • Develop AI-powered recommendation systems • Design, develop, and maintain interactive dashboards and reports using tools such as Looker Studio, Tableau, Power BI, or equivalents • Prepare summaries and presentations for management

• Perform daily quality audits against the relevant SOP across classification, attribution, mapping, and related workflows, meeting defined productivity and quality targets. • Identify anomalies — SOP defects, process gaps, and recurring error patterns and distinguish a genuine miss from an acceptable judgement call. • Comprehend and apply SOPs with minimal supervision, and flag where an SOP itself is unclear, outdated, or silent on an edge case. • Track process SLAs and turnaround commitments, ensuring audit and review queues are closed on time and any slippage is escalated early with context. • Investigate and help resolve client-raised troubleshooting requests, triaging the issue, identifying whether it stems from a data, process, or model gap, and driving it to closure with the relevant team. • Go beyond what broke to why it broke and identify preliminary root causes and explain your rationale clearly. • Propose practical solutions on quality and productivity, and partner with managers to drive them to closure on agreed milestones. • Bring a continuous-improvement mindset (RCA, basic Lean/Six Sigma thinking welcome) to reduce recurring defects over time. • Recommend process and system improvements from SOP and workflow changes to tooling and automation enhancements — that remove recurring defects at the source rather than re-catching them. • Participate in and help run calibration sessions so that audit scoring stays consistent across analysts, processes, and shifts. • Support evaluator readiness and certification so that two analysts auditing the same work reach the same verdict. • Work with your data governance counterparts to turn recurring defect trends into targeted refreshers and SOP updates, so coaching translates into measurable improvement. • Deliver clear, specific, and respectful feedback to associates, and close the loop on every audit observation. • Prepare key trend insights and share regular, clear quality reports with managers and stakeholders. • Audit AI-assisted and HiTL outputs as our Classification Engine footprint grows by evaluating where the model is reliable and where human review must stay. • Contribute structured feedback that helps improve ML model accuracy.

• Develop, implement and maintain automation solutions using RPA platforms. • Analyze requirements and map processes together with business areas. • Perform corrective, evolutionary and sustainment maintenance of automations in production environments. • Prepare and maintain technical documentation, handbooks, test scripts and change logs. • Create and execute functional and technical test scenarios, ensuring delivery quality. • Monitor robot execution, identify failures and handle incident resolution. • Apply development best practices, versioning, code review and RPA governance. • Integrate automations with APIs, databases and corporate applications. • Collaborate with multidisciplinary teams to drive continuous improvement of automated processes.