Payer Analytics and Insights Analyst/Manager

The Payer Analytics and Insights Manager is instrumental in analyzing payer data that supports shaping and refining strategies and tactics for market access, payer engagements, contract negotiations, and reimbursement. Leveraging both quantitative and qualitative insights, this role will proactively work with the market access and reimbursement operations leadership to drive informed decision-making, business processes, key performance indicators (KPIs), and uncover opportunities for growth and operational effectiveness.

Koya Medical, a privately held company founded in 2018, is a transformative healthcare company developing breakthrough treatments for venous diseases and lymphedema to enable joint contractions, patient mobility, and personalized care that is unavailable with traditional compression therapy. Koya is always looking for curious and passionate individuals who want to join a fast-paced team for a career in transforming venous and lymphatic care through innovative people-centric technologies that improve lives and empower self-care. Koya values integrity, humility, hard-work, camaraderie, and fun. We offer a base + bonus compensation package, and a competitive benefits program.

Primary responsibilities include:

• Analyze and maintain payer coverage policies and criteria to date
• Perform routine and ad hoc analyses of payer performance including outcomes from prior authorization, denials and appeals functions and identify trends
• Actively partner and participate in commercial analytics bringing a clear payer perspective into the overall commercial process and the full commercial picture (i.e. from sales order to collections outcomes)
• Partnering with cross-functional teams to ensure strategic alignment with organizational objectives
• Success in this role requires a proficient understanding and experience with payer data including familiarity in aggregating and manipulating data associated with the market access and reimbursement processes, acquisition and analysis of payer data (i.e. prior authorizations, appeals, denials, claims), attention to detail, advanced analytical capabilities and the ability to translate complex data both quantitative and qualitative into actionable insights for a range of stakeholders, including the market access and reimbursement teams and senior leadership. The successful candidate must understand the different types of payer environments including but not limited Medicare Fee for Service, Medicare Advantage, Commercial, Medicaid, and Managed Medicaid.

This role reports to the Director, Reimbursement Operations. The role is full time, exempt and will work remotely.

Essential Duties and Responsibilities

The essential functions include, but are not limited to the following:

• Analyze and maintain payer coverage policies and criteria to date,
• Assess coverage policies and analyze the influence of utilization management on market access pull through
• Perform routine and ad hoc analyses of payer performance including outcomes from prior authorization, denials and appeals functions and identify trends
• Conduct in-depth analysis of payer contract performance and develop financial models to forecast revenue and support strategic pricing decisions during contract negotiations.
• Monitor and report key performance indicators (KPIs) such as team productivity, prior authorization and appeal outcomes, reimbursement rates, and days sales outstanding (DSO) using scorecards and dashboards.
• Evaluate authorization, appeal, and claims data to uncover performance trends, identify underpayments, and highlight opportunities for revenue optimization.
• Translate complex data insights into clear, actionable presentations for both technical and non-technical audiences, including senior leadership

Minimum Qualifications

Education, Experience and Training

• Education: Bachelor's degree in a relevant field like Finance, Economics, Data Analytics, or Healthcare Administration
• Background in healthcare reimbursement or medical device industry preferred
• Proficient in advanced Excel functions and reporting tools, with expertise in Power BI, Tableau, or other business intelligence platforms.

Knowledge, Skills and Abilities

• Analytical and technical skills: Strong abilities in financial modeling, data interpretation, trend analysis, and scenario modeling.
• Domain knowledge: A solid understanding of healthcare payer contracting, reimbursement methodologies, provider