Contract and Data Analyst (Managed Care)

Job Summary

Responsible for analyzing contracts and performing contract negotiations, including monitoring and reviewing existing contracts to ensure payment compliance. This role involves communicating and resolving contract issues both internally and externally, and contributing to health system and individual contract negotiation strategies. The position also involves developing and building contract projection models essential to negotiation outcomes for the health system.

Job Responsibilities

• Analyze contracts and communicate operational impact to appropriate health system contacts.
• Develop models, perform analysis, and monitor financial performance of existing and proposed contracts.
• Monitor contract performance and compliance, ensuring contracts perform at expected levels by auditing financials and negotiating with payors for due payments if needed.
• Review and negotiate language in contracting negotiation processes.
• Develop, produce, and maintain data sets required for contract analysis.
• Develop and maintain departmental processes to manage contracts.
• Resolve contractual disputes with payors by collaborating with various health system entities and related parties.
• Analyze, develop, and test contract projection models essential to negotiation outcomes for both physician and hospital contracts/reimbursement.
• Build programming and perform ongoing analysis to maintain the integrity of financial expectations of managed care contracts.
• Resolve programming issues related to rate and revenue codes operations to maximize revenue potential.
• Ensure through testing that the system build is developed and performing effectively, collaborating with the team to enhance contract modeling.
• Perform other related duties as assigned to fulfill department responsibilities.

Decision Making

Responsible for carrying out non-routine procedures under constantly changing conditions, following general instructions from a supervisor.

Working Relationships

• Coordinate activities of others (not in a supervisory capacity).
• Work with internal customers via telephone or face-to-face interaction.
• Engage with external customers via telephone or face-to-face interaction.
• Collaborate with other healthcare professionals and staff.
• Frequently work with individuals at Director level or above.

Required Skills & Experience

• 3-4 years of related experience.
• Experience with health plan insurance contracting and reimbursement for providers and facilities.
• Ability to complete and maintain certification in assigned application modules.
• Ability to work independently and within a team across multiple disciplines.
• Ability to establish and meet work schedules within limited time frames and under tight deadlines.
• Analytical ability to solve both business and technical problems.
• Proficiency in Microsoft Excel, Word, Power BI, and Access.
• Excellent interpersonal, written, and oral communication skills.
• Attention to detail as required in the analysis and examination of complex information.

Preferred Skills & Experience

• Experience with Microsoft Access, data warehouse applications, contract negotiations, contract financial modeling, contract language interpretation, and relevant systems.

Schedule Notes

• Position Type: Direct Hire
• Shift/Schedule Details: Days/Mon - Fri / 8-5pm
• Incentives: Possible relocation package

Seeking a professional with 3 4 years' experience in managed care, health plan contracting, and provider reimbursement. Must have strong analytical skills, experience with contract modeling and financial analysis, and the ability to maintain relevant certifications. Experience in a health system, clinic, or surgery center and familiarity with EHR systems required; Power BI experience is a plus. A Bachelor's degree in Business or related field is required.