Overview
Schedule: Days: M-F
Job Location Type: Hybrid or Remote
This role supports managed care contracting activities by translating payer contract terms, reimbursement methodologies, patient volume, utilization trends, and contract performance data into actionable financial and operational insights. The position partners with Managed Care and Finance leaders to evaluate payer performance, identify opportunities to strengthen reimbursement, support contract modeling and reporting, and inform revenue, payer contract, and network strategy decisions.
Responsibilities
- Support modeling and financial review of hospital, physician, ancillary, fee-for-service, and value-based managed care contracts using Excel and/or other modeling tools to quantify contractual value, reimbursement impact, and financial opportunity.
- Evaluate the financial impact of changes in payer rates, contract terms, reimbursement methodologies, and payer policies to support informed decision-making during contract negotiations and renewals; translate complex payer contracts and payment methodologies into clear analysis.
- Use Business Intelligence (BI), financial reporting, and contract management tools to gather, validate, organize, and analyze data related to payer contract performance, reimbursement trends, volume shifts, payer mix, denials, underpayments, and other indicators impacting managed care results.
- Design, develop, and deliver standard and ad hoc managed care financial reports, dashboards, and analyses using SQL, Power BI, and other tools.
- Reporting may include payer policy quantitative impact analysis, service line and facility volume trends, reimbursement variance analysis, contract performance summaries, litigation or audit support, chargemaster-related analysis, and other managed care finance support as needed.
- Maintain organized contract, rate, and payer-related information to support accurate reporting, timely financial analysis, contract administration, and stakeholder communication.
- Assist with data validation, issue tracking, and reconciliation of information received from payers, facilities, revenue cycle teams, and internal business partners.
- Review, summarize, and abstract managed care contract language, rate exhibits, payer notices, and reimbursement provisions that significantly impact hospital reimbursement, revenue expectations, operational workflows, or contract compliance.
- Monitor managed care reporting schedules and support timely updates to recurring reports, trackers, contract files, payer matrices, financial summaries, and other departmental tools used for contract performance oversight and revenue strategy.
- Partner with managed care negotiators, finance team members, revenue cycle stakeholders, and facility contacts to research questions, locate missing information, resolve data discrepancies, support contract implementation needs, and ensure updated contract information is communicated to appropriate stakeholders.
- Support managed care contract implementation activities by coordinating contract updates, distributing new or revised contract information, maintaining accurate documentation, and assisting with follow-up items related to payer communications, operational readiness, reimbursement impacts, and stakeholder questions.
- Identify trends, risks, and opportunities related to payer performance, reimbursement variance, contract compliance, and managed care financial outcomes; escalate findings and recommend practical next steps to support revenue optimization and operational alignment.
Requirements
- Bachelor’s Degree required in Business, Finance, Accounting, Healthcare Administration, Mathematics, Information Systems, or another related quantitative or business field.
- Minimum of 3 years of experience in healthcare finance, managed care, revenue cycle, reimbursement analysis, payer contracting support, financial analysis, or a related healthcare business function.
- Travel: Up to 10%
- Must be authorized to work in the United States without employer sponsorship.
Preferred Qualifications
Compensation & Benefits
In addition to base compensation, this position offers:
- Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
- Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
- Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
- Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
- Professional Development: Ongoing learning and career advancement opportunities.
Location
Hybrid or Remote
Equal Opportunity Employment
The employer is an Equal Opportunity Employer and is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.