Overview
The Managed Care Contracting Analyst is responsible for financial modeling and economic analysis to support fee-for-service and risk-based contracting strategies. This role evaluates contract performance, forecasts value-based reimbursement impacts, and identifies optimization opportunities for the Collaborative Care Organization and health system. The analyst collaborates closely with Managed Care Contracting and Finance teams to inform negotiations and strategic decisions through data-driven insights. The position involves generating reports, dashboards, and analytical solutions according to business rules and specifications, supporting the Managed Care Contracting department by analyzing and reviewing the financial performance of managed care contracts.
Responsibilities
- Perform contract analysis and evaluation to assess performance and identify opportunities for improvement, cost savings, and revenue enhancement.
- Analyze and monitor payer trends, managed care contract compliance, contract and payer yield, and indicators reflecting new revenue or charge capture opportunities aligned with organizational goals.
- Conduct contract modeling and scenario analysis to assess the impact of proposed contract changes.
- Manage data collection, validation, and maintenance related to managed care contracts.
- Develop and maintain reporting mechanisms to monitor key performance indicators, financial metrics, and contract performance.
- Provide regular reports to leadership and relevant stakeholders.
- Support charge master benchmarking and revenue analytics by providing data for strategic pricing recommendations.
- Collaborate with the contract negotiation team to provide data-driven insights and recommendations during payer contract negotiations.
- Assist in developing negotiation strategies to optimize reimbursement rates and contractual terms.
- Work closely with cross-functional teams including finance, legal, and operational departments to ensure alignment in contract management strategies.
- Collaborate with external stakeholders such as payers and regulatory bodies to stay informed about industry trends and changes.
- Implement systems for monitoring and tracking key performance indicators related to managed care contracts.
- Inform leadership on payer performance relative to Joint Operating Committee content.
- Act as liaison between Managed Care Contracting, Finance, and IT during the contract build process within the electronic health record by interpreting and applying contract terms and completing post-build audits to validate accuracy.
Requirements
Education
- Bachelor's degree in healthcare administration, business, finance, or a related field required.
- Associate degree with relevant managed care contracting experience may be considered.
Experience and Skills
- Minimum of three to five years of experience in healthcare analytics, managed care contracting, or a related field.
- Experience utilizing and navigating an Electronic Health Record system; EPIC preferred.
- Strong interpersonal and organizational skills.
- Excellent verbal and written communication skills.
- Knowledge of healthcare medical benefits.
- Strong project management and operational skills.
- Excellent understanding of healthcare reimbursement methodologies and managed care principles.
- Strategic thinking with strong analytical skills.
- Contract modeling experience.
- Proficiency with Windows environment applications including Word, Excel, Access, and PowerPoint.
- Experience with SQL and business or population health platforms.
- Ability to work independently or in a team, including training and guiding others on complex assignments.
Physical and Mental Requirements
- Exposure to stressful situations including public contact and situations involving trauma, grief, and death.
- Ability to wear personal protective equipment including latex materials or appropriate substitutes.
- Ability to move freely about the facility with or without an assisted device and perform job functions as outlined.
- Overall vision and hearing necessary with or without assisted devices.
- Frequently required to sit, stand, or walk for long periods; may require stooping, kneeling, or crouching.
- Some exposure to bloodborne pathogens and other potentially infectious materials; must follow bloodborne pathogen and TB testing protocols as required.
- Ability to handle multiple tasks, work independently, maintain regular attendance, and stay alert.
- Dexterity including handling, reaching, grasping, fingering, and feeling; may require repetitive movements regularly.
- Physical demand level: Sedentary. Must be able to occasionally (0-33% of the workday) lift or carry 0-10 lbs.