Managed Care Analyst

Family HealthCare Network•Visalia, CA

About The Position

The Managed Care Analyst is responsible for using health plan data to validate, contrast, and track opportunities for revenue growth and compiling external and internal data reports to ensure compliance and efficiency. This role involves producing, validating, and interpreting data for health plan membership and capitation reports, and developing internal status reports to meet organizational revenue goals. The analyst will define data requirements, develop data collection and analysis tools, and perform data validation to ensure reporting integrity. They will identify, investigate, and report discrepancies, maintain a work plan for post-production reports, and produce monthly reports on payer revenue. Additionally, the analyst will maintain a Compliance Data Base for all Health Plans and special projects, evaluate the profitability of payer relationships for Medicare, Medicare Advantage, Medi-Cal Managed Care, and Commercial Health Plans, and analyze utilization data to identify opportunities for cost control. The role also includes assisting with data analysis efforts of other staff, assessing the effectiveness of internal workflows on revenue streams, and ensuring organizational policies align with contract terms. Adherence to the Attendance and Absenteeism Policy is required, recognizing that regular attendance is an essential function. The ability to present to and work at any FHCN location is also necessary. Other duties may be assigned.

Requirements

Effective June 1, 2026, all individuals hired into the role must possess proficiency in written and verbal communication, basic mathematics, computer applications, and technical systems.
Required completion of an Associate’s Degree program with a recognized major and a minimum cumulative GPA of 2.5; OR A combination of relevant experience and completion of a high school diploma with a minimum cumulative GPA of 2.5, or General Educational Development (GED) with a minimum overall score of 162.5.
If an individual has completed a degree at a higher level than required by the role and had a stronger GPA in that program, they may provide proof of GPA from that degree in lieu of the high school diploma or associate’s degree.
Healthcare-related knowledge frequently acquired through completion of a trade school, para-professional, or certificate type program.
A minimum of two years of relevant experience, including experience in healthcare, preferably in a managed care environment.
A minimum of two years of experience in data analysis and/or financial modeling.
Demonstrate strong analytical and problem-solving skills.
Ability to prepare more complex documents in Microsoft Word, including creating tables, charts, graphs, and other elements.
Ability to use Advanced Microsoft Excel to analyze data, including formulas, functions, lookup tables, and other standard spreadsheet elements.
Ability to develop sophisticated presentations in Microsoft PowerPoint, including embedded objects, transitions, and other elements.
Job duties require employees to effectively communicate their opinions and extrapolations of information they collect, synthesize/analyze.
Exercises tact and diplomacy to resolve mild conflicts or disagreements.
Compiles, analyzes and prepares information in an effective written form, including correspondence, reports, articles, or other documentation.
Effectively conveys technical information to non-technical audiences.

Nice To Haves

Experience in a managed care environment.
Experience in financial modeling.

Responsibilities

Producing, validating, and interpreting data for health plan membership and capitation reports.
Developing internal status reports to meet organizational revenue goals.
Defining data requirements and developing data collection and analysis tools for payer-specific identities.
Performing data validation to ensure integrity of reporting.
Identifying, investigating, and reporting discrepancies in the data or workflows.
Maintaining a work plan for post-production reports and presentations.
Producing monthly reports on payer revenue.
Maintaining Compliance Data Base for all Health Plans and special projects.
Using collected data to evaluate the profitability of payer relationships for all lines of business: Medicare and Medicare Advantage Five Star Performance, Medi-Cal Managed Care Health Plan Audit/Compliance and Incentives, and Commercial Health Plans P4P and HEDIS Performance.
Health plan contract modeling.
Analyzing utilization data such as PCP visits, ER visits, hospital admissions, and bed days and identifying opportunities to control utilization.
Assisting data analysis efforts of other FHCN staff and departments as needed.
Assessing the effectiveness of internal workflow impact on health plan revenue streams and ensuring current organizational policies follow existing contract terms.
Adhering to the Attendance and Absenteeism Policy.
Ability to present to and work at any FHCN location.
Performing other duties as assigned.