Managed Care Contracting Analyst
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Managed Care Contracting Analyst analyzing healthcare contract performance and payor reimbursement for HOPCo. Building financial models, querying claims data, and supporting Revenue Cycle decisions.
Responsibilities:
- Prepare analyses of the financial and operational performance of healthcare contracts, including regulatory rate and other changes
- Identify performance issues and recommend areas for improvement
- Analyze Medicaid and other managed care products, including HMO, PPO, and POS products
- Monitor and trend third-party reimbursement, including denial analysis
- Create financial models and reports for existing and new reporting needs
- Support management by locating data sources and collecting data under tight time constraints
- Identify and analyze utilization patterns driving healthcare costs and recommend actions to improve financial performance
- Review shared-risk claims, capitation, risk-pool settlements, and health-plan reports
- Submit shared-risk discrepancy reports within required timelines and formats
- Create payor reimbursement reports for senior leadership
- Recommend changes in application utilization to Revenue Cycle
- Create queries to extract financial and claims data for analytical and statistical models
- Identify and communicate trends and potential issues to management
- Serve as liaison between health plans and Revenue Cycle
- Collaborate with Contracting/Credentialing to optimize health payor reimbursement
- Analyze health payor optimization within each market
- Create and schedule JOCs with applicable health-plan representatives
- Update and audit the Clearwave system to keep provider information current
- Extract and query data from multiple sources and systems, compiling written and verbal reports and presentations
Requirements:
- High school graduate or equivalent
- Bachelor’s Degree in Finance or Healthcare Administration preferred
- Minimum of three years’ experience working in an analytic or analyst role in a healthcare environment
- In-depth knowledge of physician reimbursement
- Two or more years’ experience with Revenue Cycle Billing
- Experience using relational databases, decision support systems, analysis and modeling
- Knowledge of the payor reimbursement process
- Knowledge of computer systems
- Knowledge of Health Plan Billing claim paperwork and timelines
- Knowledge of Health Plan Billing timelines and regulations
- Ability to establish good working relationships with internal and external customers
- Ability to communicate effectively with staff, leadership, health plan representatives, and other departments
- Ability to organize and efficiently manage daily work activities/projects
- Ability to exercise independent judgment and decision-making
- Ability to meet demanding deadlines
- CORE Creed must be read and signed
- OSHA requirements and training, including safety training
Benefits:
- Full-time employment
- CORE Creed must be read and signed
- OSHA safety training
Similar Jobs
Reimbursement Analyst
Remote Reimbursement Analyst analyzing charges, collections, RVUs, and reimbursement reports for University of Mississippi Medical Center. Supporting revenue-cycle management and senior leadership reporting.
Health IT Analyst – Dental
Health IT Analyst configuring Dentrix and Cerner EHR solutions for Indian Health Service modernization. Supporting dental workflows, billing, interoperability, compliance, and system optimization for federal government healthcare.
Senior EDI Analyst
Senior EDI Analyst managing partner integrations, mappings, and ERP data exchange for RealTruck, a global truck and off-road accessory manufacturer. Troubleshooting and improving EDI systems across locations.
Client Import Analyst
Client Import Analyst supporting customs entries, tariff databases, compliance, and shipment release. Serving clients within Livingston’s international trade and customs brokerage operations.
System Analyst II – Operational Reporting
Systems analyst supporting operational reporting and IT projects for Cleveland Clinic Health System. Developing requirements, process flows, project documentation, and technology solutions.
Analyst II, Billing
Billing Analyst II executing monthly billing, reconciliation, and data quality controls for Perch Energy’s community solar business. Investigating billing issues and improving operational processes.
Staalnemer, Analist Milieu
Environmental sampler/analyst conducting asbestos air measurements and on-site microscopy for Eurofins Scientific. Driving independently to remediation sites and preparing immediate client reports.
Data Surveillance Analyst
Data Surveillance Analyst supporting Parexel’s clinical development solutions through data surveillance, risk indicators, and central monitoring. Reviewing data quality signals and escalating study issues.
Triage & Assessment Analyst
Triage analyst assessing federal applications for Koniag’s ICAM and Zero Trust solutions. Evaluating Okta and SailPoint integration readiness, risks, and enablement pathways.
Benefits Analyst
Benefits Analyst supporting benefits administration, issue resolution, auditing, and reporting for Mercy healthcare caregivers. Fully remote role requiring HRIS, Excel, and customer service expertise.
Processing Analyst
Processing Analyst managing commercial loan documentation and underwriting workflows for World Business Lenders. Coordinating customers, Sales, Title, Valuation, Legal, and Closing teams.
Senior Configuration Analyst
Sr. Configuration Analyst supporting SAIC’s VA application modernization and cloud migration. Automating configuration management, CI/CD, release engineering, and repeatable deployments.
HRIS Analyst
HRIS Analyst owning Workday Payroll, Time Tracking, and Absence Management for Pennant’s U.S. healthcare services organization. Ensuring compliant payroll operations, integrations, reporting, and system improvements.
Service Desk Analyst, Level 1 – 3rd Shift
Service Desk Level 1 Analyst providing overnight first-level support for DYOPATH’s IT services. Troubleshooting user devices, software, networks, and service requests remotely.
Senior Analyst
ESA Section 7 analyst conducting protected-species impact analyses and consultations. Supporting Ocean Associates’ marine fisheries research and government clients.
Payment Variance Analyst
Payment variance analyst identifying contractual underpayments and payer discrepancies for Med-Metrix. Analyzing claims, reimbursement methodologies, denials, and collections.
Senior HRIS Analyst – Workday
Senior HRIS Analyst optimizing Optiv’s Workday HCM platform, security, and HR processes. Supporting system enhancements, integrations, testing, and stakeholder solutions for Optiv’s cybersecurity business.
Implementation Analyst
Implementation Analyst managing client onboarding, integrations, and launch processes for McKesson’s CoverMyMeds prescription-drug software. Coordinating timelines, configurations, technical support, and client training.
Senior Service Delivery Analyst
Senior Service Delivery Analyst using Epic Clarity, Snowflake, and advanced SQL for R1's healthcare revenue cycle operations. Delivering client-ready insights, identifying defects, and driving operational improvements.
Contract Analyst 11
Remote Contract Analyst II managing clinical-trial and vendor agreements for ICON, a global healthcare research organisation. Reviewing contracts, negotiating terms, and mitigating contractual risks.