Managed Care Contracting Analyst

Augusta Health•Fishersville, VA

About The Position

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 to inform negotiation strategy, quantify the financial impact of proposed rates and terms, and support the health system’s long-term sustainability. The role monitors executed contracts, identifies payment variances and payer policy changes, and supports resolution of escalated payer issues in collaboration with Revenue Cycle and other departments. Reporting to the Director of Managed Care Contracting, the Analyst also maintains the contract repository, tracks key contract terms and renewal dates, and prepares materials for payer meetings, negotiations, and executive reporting. The position supports contract modeling and financial analysis, payer performance monitoring, negotiation strategy, contract administration and data management, issue resolution, regulatory and market intelligence, and ongoing process improvement. The Analyst collaborates with Revenue Cycle, Finance, Population Health, payer representatives, and other stakeholders, and provides analytical support for value-based care arrangements. Augusta Health is an independent, nonprofit health system in Fishersville, Virginia, with inpatient and outpatient services, including a 255-bed medical center, 40 medical group practice locations, and four urgent care centers.

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 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.
Ability to present analytical findings clearly to non-technical audiences.
Strong knowledge of healthcare reimbursement methodologies, including DRG, per diem, fee schedule, percent-of-charge, and value-based payment models.
Advanced Excel skills, including building, maintaining, and quality-checking complex contract and reimbursement models.
Proficiency with data analysis and reporting tools such as SQL, Power BI, or similar, and ability to work with large claims and charge datasets.
Strong analytical and critical thinking skills, attention to detail, and 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 and ability to translate technical analyses into clear recommendations.
Strong organizational and project management skills and ability to manage multiple priorities and deadlines.
Ability to collaborate 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.
Eligible to work in the United States and meet Virginia state employment requirements.
No licensure or certification is required.

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, such as Meditech Data Repository, SQL, or Power BI.
Working knowledge of value-based care arrangements and alternative payment models.
Experience 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.

Responsibilities

Build and maintain financial models of current and proposed payer rates, contract terms, and payment methodologies to quantify net revenue impact.
Perform what-if modeling of rate proposals, payment methodologies, and utilization scenarios to support negotiation strategy.
Analyze claims, charge, and reimbursement data to develop payer-specific baselines, trends, and benchmarks.
Prepare rate comparisons, yield analyses, payer scorecards, and recurring contract performance reports for negotiations, executives, and stakeholders.
Support budgeting and forecasting by projecting the impact of rate changes, payer mix shifts, and new agreements.
Monitor executed contracts by comparing expected and actual reimbursement and identifying payment variances and underpayments.
Research payment variance root causes 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 performance indicators and dashboards for contract yield, payer mix, denials, and payment timeliness.
Prepare data, models, exhibits, and briefing materials for payer negotiations led by the Director.
Evaluate payer proposals and counterproposals, quantify financial impact, and identify unfavorable terms.
Assist with negotiation targets, priorities, and renewal calendars for the managed care contract portfolio.
Support analyses requested by external managed care consultants and advisors and incorporate 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.
Summarize contract provisions and communicate rate and term changes to Revenue Cycle, Patient Access, and other affected departments.
Support loading and implementation of contract terms in applicable systems and validate expected reimbursement calculations.
Maintain data governance, quality, and integrity standards across contract models and reporting; document methodologies, assumptions, and data sources.
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 data reliability and timely issue resolution.
Respond to information requests from external auditors, consultants, and payers as directed.
Provide analytical support for value-based care arrangements, including tracking performance against quality and cost targets.
Maintain current knowledge of federal and state managed care regulations, 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; recommend process improvements; and participate in relevant professional associations and peer networks as appropriate.

Benefits

Medical, dental, and vision coverage.
Retirement savings plans and financial wellness support programs.
Earned Wage Access Program for eligible team members.
Paid time off and flexible scheduling.
Career development programs and advancement opportunities.
Personalized onboarding with dedicated preceptors and ongoing educational support.
Tuition reimbursement.
Onsite childcare.
Free onsite parking.
24/7 armed security.
Health Fitness Reimbursement Program.
Onsite credit union and pharmacy.
Competitive pay with shift and weekend differentials.
Employee discounts at the cafeteria, gift shop, pharmacy, and local entertainment venues.