Managed Care Performance Analyst, Full Time, First Shift

UC Health•Cincinnati, OH

3d•Onsite

About The Position

Under minimal supervision, the Managed Care Performance Analyst evaluates financial, operational, and contractual performance across UC Health commercial and government payer agreements. The analyst interprets reimbursement terms, models contracted rate changes, validates expected versus actual payments, and analyzes underpayments, denials, utilization, and net revenue trends to identify financial exposure and recovery opportunities. This role monitors payer compliance with contract requirements, supports issue escalation and resolution, and develops defensible analyses for negotiations, amendments, and operational improvement. The analyst collaborates with Managed Care, Finance, Revenue Cycle, Contracting, Clinical Operations, and payer representatives to deliver actionable performance reporting and recommendations to leadership. The position is responsible for analyzing payer reimbursement performance and quantifying contract-related revenue opportunities and financial exposure, including rate changes, underpayments, denials, recoupments, and implementation variances. It develops financial models and recovery estimates to inform payer negotiations, issue escalation, and leadership decisions. There is no direct budget authority. The position works in a normal office environment, with travel to various hospitals and work locations necessary. Work hours may vary from time to time depending on business needs. Regular and predictable on-site attendance is required.

Requirements

Bachelor's degree.
Three to five years of equivalent experience in managed care contracting, reimbursement analysis, healthcare finance, revenue cycle analytics, or payer performance.
Knowledge of managed care contracting and commercial and government payer reimbursement methodologies, including DRG, APC, fee schedules, case rates, percent-of-charge, and stop-loss provisions.
Ability to interpret executed payer contract language, reimbursement appendices, administrative provisions, and payer payment policies.
Experience analyzing healthcare claims, remittance data, denials, appeals, underpayments, recoupments, and reimbursement variances.
Strong financial and analytical skills in rate modeling, forecasting, trend analysis, variance analysis, and quantification of net revenue impact.
Ability to reconcile expected reimbursement to actual payer payments and investigate complex payment methodology discrepancies.
Knowledge of contract compliance monitoring, payer issue documentation, audit controls, and implementation validation.
Ability to develop evidence-based payer escalation materials and recommend financially sound issue-resolution priorities.
Excellent written and verbal communication skills to explain complex reimbursement and operational findings to payer representatives and senior leadership.
Advanced Excel and healthcare reporting experience.
Strong organization and project management skills to manage multiple payer contracts, analytical requests, and deadlines.
Ability to collaborate across Managed Care, Contracting, Finance, Revenue Cycle, Clinical Operations, and external payers while exercising independent judgment.
Demonstrated commitment to accuracy, confidentiality, integrity, accountability, and continuous improvement.
Regular and predictable on-site attendance is required; travel to various hospitals and work locations is necessary.

Nice To Haves

SQL, Power BI, Tableau, Epic, contract modeling, or revenue cycle analytics platform experience.

Responsibilities

Analyze reimbursement performance for assigned commercial, Medicare Advantage, Medicaid managed care, and other payer contracts using contract terms, fee schedules, claims, remittances, and financial data.
Validate expected versus actual reimbursement for inpatient, outpatient, professional, and specialty services; identify underpayments, payment methodology errors, and unfavorable contract performance.
Model financial impacts of proposed rate changes, amendments, service-line provisions, stop-loss terms, and payer policy changes; develop contract-level forecasts and scenario analyses.
Identify trends in net revenue, yield, case mix, utilization, and payer performance, and quantify financial opportunities or exposure.
Analyze denial, downgrade, recoupment, payment variance, and appeal patterns to identify systemic reimbursement issues and root causes.
Quantify affected claims, reimbursement shortfalls, recovery opportunities, and operational impact to prioritize payer escalations.
Partner with Revenue Cycle and payer contacts to validate issues, develop evidence-based dispute analyses, track corrective action, and measure resolution outcomes.
Monitor payer adherence to contractual claims processing, appeals, audit, and payment provisions; escalate material trends to Managed Care leadership.
Monitor payer compliance with executed agreements, reimbursement appendices, administrative requirements, performance commitments, and service-level provisions.
Maintain contract performance controls, issue logs, validation documentation, and audit-ready support for payer discussions and internal reviews.
Evaluate reimbursement policy changes and payer implementation of negotiated terms; identify variances between executed language and operational payment practices.
Track unresolved contract implementation issues, deadlines, financial exposure, and corrective actions, and timely escalate material risks.
Develop recurring payer scorecards and executive reports on reimbursement yield, net revenue, denials, underpayments, contract compliance, and financial performance.
Perform trend, variance, benchmark, and root-cause analyses across payer, product, facility, service line, and reimbursement methodology.
Work with Finance and Revenue Cycle to validate assumptions, reconcile reporting differences, and estimate financial impacts of payer performance issues.
Communicate concise findings and recommendations to support leadership decisions and prioritization.
Provide analytical support for payer negotiations, renewals, amendments, and implementation by evaluating contract provisions and projected reimbursement outcomes.
Collaborate with Contracting, Finance, Revenue Cycle, and operational stakeholders to identify workflow and payer-policy issues affecting reimbursement.
Support validation of contract loading and rate implementation and recommend monitoring or corrective actions.
Perform other duties as assigned.