Managed Care Analyst
About The Position
The Managed Care Analyst plays a pivotal role in driving strategic decision-making across the health system by capturing, transforming, interpreting, and presenting complex healthcare data. This position leads analytics related to payer contracting, payment modeling, and revenue cycle key performance indicators (KPIs), providing critical insights that support successful contract negotiations and ongoing payer performance monitoring. Reporting to the Assistant Director of Managed Care Contracting, the Analyst partners with teams across Revenue Cycle, Finance, Clinical Operations, and Executive Leadership. Leveraging advanced data tools and EMR systems, the Analyst delivers actionable intelligence that enhances financial outcomes, operational efficiency, and patient access to care.
Requirements
- Bachelor's Degree in Data Science, Analytics, Health Administration, Public Health, Finance, or a related quantitative or healthcare discipline
- At least 4 year(s) of experience in managed care analytics, healthcare finance, payer contracting or a related field.
- Advanced knowledge of commercial and government reimbursement, managed care contracting, fee schedules, revenue cycle management, and EMR software systems such as Epic.
Nice To Haves
- Master's Degree in Health Administration, Public Health, Business, or Data Analytics with at least 7 year(s) of experience in managed care analytics or contract negotiation.
- Experience in academic medical center or large integrated health system.
- Certified Professional in Healthcare Quality (CPHQ)
- Certified Health Data Analyst (CHDA)
- NCQA HEDIS Compliance Auditor (CHCAA)
- Project Management Professional (PMP)
Responsibilities
- Models commercial and government payment methodologies for physician, ambulatory, and hospital services.
- Analyzes contract proposals using reimbursement methods such as fee schedules, DRG, case rates, and stop-loss.
- Leverages tools like Experian MPV and FinThrive for enhanced contract modeling.
- Synthesizes contract terms to support negotiation strategies.
- Evaluates contract performance and compliance.
- Extracts and interprets data from EMRs (e.g., Epic, Athena) and financial systems.
- Develops dashboards and reports for Managed Care, Revenue Cycle, and Executive stakeholders.
- Identifies risks and opportunities in payer performance and reimbursement.
- Synthesizes complex datasets into actionable recommendations.
- Supports strategic initiatives with data-driven insights.
- Monitors key performance indicators related to claims, denials, and payments.
- Identifies trends in overpayments, underpayments, and global denials.
- Collaborates with Revenue Cycle teams to resolve payer issues.
- Uses EMR reporting capabilities to enhance decision-making.
- Supports compliance and audit readiness.
- Prepares and presents findings to department and executive leadership.
- Translates complex analytics into clear, actionable insights.
- Serves as liaison between internal teams and external payers.
- Participates in cross-functional meetings and payer summits.
- Supports education and training on managed care analytics.
- Monitors changes in reimbursement models and payer policies.
- Conducts market research on healthcare trends and regulations.
- Attends professional development events and webinars.
- Evaluates emerging technologies and analytics tools.
- Adapts to evolving payer environments and contract structures.
- Represents department needs in EMR system maintenance and upgrades.
- Collaborates with IT and vendor teams to optimize reporting tools.
- Tests and validates system changes related to managed care analytics.
- Documents system requirements and workflows.
- Provides feedback for continuous improvement.
Benefits
- Teacher Retirement System of Texas (TRS)
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
