Managed Care Contracting Analyst

Augusta Health•Fishersville, VA

1d•$28 - $42•Onsite

About The Position

The Managed Care Contracting Analyst plays a critical role in supporting Augusta Health’s mission and advancing departmental goals through measurable performance indicators and service excellence. This position contributes to a collaborative, patient-centered environment and helps drive outcomes aligned with organizational priorities. Reporting to the Director of Managed Care Contracting, the Managed Care Contracting Analyst provides analytical, financial modeling, and operational support for Augusta Health’s managed care contracting function across hospital, ancillary, and employed physician services. The Analyst develops contract models, reimbursement analyses, and payer performance reporting that inform negotiation strategy, quantify the financial impact of proposed rates and terms, and support Augusta Health’s long-term sustainability as an independent community health system. The Analyst monitors executed contracts on an ongoing basis, identifying payment variances, underpayments, and payer policy changes, and supports the resolution of escalated payer issues in collaboration with Revenue Cycle and other departments. Working under the direction of the Director, the Analyst also maintains the contract repository, tracks key contract terms and renewal dates, and prepares materials for payer meetings, negotiations, and executive reporting.

Requirements

Bachelor’s degree in Finance, Accounting, Business Administration, Healthcare Administration, Economics, Mathematics, or a related field; or an equivalent combination of education and relevant analytical experience
Three (3) years of progressive experience in healthcare finance, managed care, revenue cycle, decision support, or payer analytics.
Demonstrated experience building financial models and analyses in Excel, including reimbursement, rate, or net revenue modeling.
Experience working with healthcare claims, charge, or reimbursement data and interpreting payer contract terms.
Demonstrated ability to present analytical findings clearly to non-technical audiences.
Eligibility to work in the United States and meet Virginia state employment requirements

Nice To Haves

Master’s degree (MBA, MHA, MSF, or equivalent)
Coursework or formal training in healthcare finance, statistics, or data analytics
Certified Revenue Cycle Representative (CRCR) or Certified Healthcare Financial Professional (CHFP) through HFMA
Certified Public Accountant (CPA)
Lean Six Sigma Green Belt
Membership in HFMA or comparable professional associations
Experience supporting managed care contract negotiations within a hospital, health system, or payer organization.
Experience with contract modeling tools, decision support systems, or healthcare data warehouses (e.g., Meditech Data Repository, SQL, Power BI, or similar).
Working knowledge of value-based care arrangements and alternative payment models.
Experience working within an independent community health system or similarly complex healthcare organization.
Prior experience in a hospital, healthcare system, or related service-oriented environment
Familiarity with Augusta Health’s systems, workflows, or organizational culture is a plus
Strong knowledge of healthcare reimbursement methodologies, including DRG, per diem, fee schedule, percent-of-charge, and value-based payment models.
Advanced Excel skills, with the ability to build, maintain, and quality-check complex contract and reimbursement models.
Proficiency with data analysis and reporting tools (e.g., SQL, Power BI, or similar) and the ability to work with large claims and charge datasets.
Strong analytical and critical thinking skills, with attention to detail and a commitment to data accuracy and integrity.
Ability to read and interpret managed care contract language, rate exhibits, and payer policies.
Working knowledge of federal and state regulations affecting managed care, including CMS requirements, price transparency, and the No Surprises Act.
Excellent written and verbal communication skills, with the ability to translate technical analyses into clear recommendations.
Strong organizational and project management skills, with the ability to manage multiple priorities and deadlines.
Ability to work collaboratively with Revenue Cycle, Finance, Population Health, and payer representatives to research and resolve issues.
Ability to handle confidential information with discretion and sound judgment.
Self-directed, curious, and committed to continuous learning and process improvement.

Responsibilities

Build and maintain financial models of current and proposed payer rates, terms, and payment methodologies to quantify net revenue impact.
Perform what-if modeling of alternative rate proposals, payment methodologies, and utilization scenarios in support of negotiation strategy.
Analyze claims, charge, and reimbursement data to develop payer-specific baselines, trends, and benchmarks.
Prepare rate comparisons, yield analyses, and payer scorecards for use in negotiations and executive reporting.
Support budgeting and forecasting with projected impacts of rate changes, payer mix shifts, and new agreements.
Monitor executed contracts on an ongoing basis, comparing expected to actual reimbursement and identifying payment variances and underpayments.
Research root causes of payment variances and coordinate with Revenue Cycle to pursue recoveries and corrections.
Track payer policy changes, fee schedule updates, and contract amendments, and assess their financial and operational impact.
Maintain key performance indicators and dashboards for contract yield, payer mix, denials, and payment timeliness.
Prepare recurring contract performance reports for the Director, CFO, and other stakeholders.
Prepare data, models, exhibits, and briefing materials in support of payer negotiations led by the Director.
Evaluate payer proposals and counterproposals, quantifying financial impact and identifying unfavorable terms.
Assist in developing negotiation targets, priorities, and renewal calendars for the managed care contract portfolio.
Support analyses requested by external managed care consultants and advisors, and incorporate their benchmarking into internal work products.
Attend payer meetings and negotiations as requested, documenting outcomes and follow-up items.
Maintain a centralized repository of executed agreements, amendments, rate exhibits, and key contract terms.
Track contract effective dates, renewal dates, termination windows, and notice requirements to prevent lapses or unfavorable auto-renewals.
Summarize key contract provisions and communicate rate and term changes to Revenue Cycle, Patient Access, and other affected departments.
Support accurate loading and implementation of contract terms in applicable systems, validating expected reimbursement calculations.
Ensure data governance, quality, and integrity standards are maintained across contract models and reporting.
Document modeling methodologies, assumptions, and data sources to ensure analyses are reproducible and auditable.
Research and support resolution of escalated payer issues involving payment promptness, denials, authorizations, credentialing, and payer-member concerns.
Collaborate with Revenue Cycle, Finance, and Population Health to ensure reported data is reliable and issues are addressed timely.
Respond to information requests from external auditors, consultants, and payers as directed.
Provide analytical support for value-based care arrangements, including performance tracking against quality and cost targets.
Maintain current knowledge of federal and state regulations affecting managed care, including CMS requirements, price transparency, and the No Surprises Act.
Monitor market trends, payer product developments, and competitor activity to inform strategy recommendations.
Support compliance with contract-related regulatory reporting and documentation requirements.
Model Augusta Health’s values and contribute to a collaborative, results-oriented team culture.
Pursue continuous learning in managed care, reimbursement, and analytics through professional development opportunities.
Identify and recommend process improvements to enhance the accuracy and efficiency of contracting analyses.
Participate in professional associations and peer networks related to healthcare finance and managed care as appropriate.

Benefits

Comprehensive insurance package including medical, dental, and vision coverage
Retirement savings plans and financial wellness support programs
Earned Wage Access Program, allowing eligible team members to access a portion of earned wages before payday
Generous paid time off and flexible scheduling to promote work-life balance
Career development programs including clinical ladders, shared governance, and advancement opportunities
Personalized onboarding with dedicated preceptors and ongoing educational support
Tuition reimbursement and access to onsite childcare
Free onsite parking, 24/7-armed security for your safety, a Health Fitness Reimbursement Program, and an onsite credit union and pharmacy
Competitive pay with shift/weekend differentials
Employee discounts at the cafeteria, gift shop, pharmacy, and local entertainment venues (i.e., movie tickets)