Managed Care Analyst

Position Summary

The Hospital Managed Care Analyst supports the financial and strategic goals of the hospital by analyzing managed care contracts, payer performance, and reimbursement trends. This role ensures accurate revenue forecasting, supports contract negotiations, and identifies opportunities for financial optimization.

Key Responsibilities

• Contract Analysis & Modeling
• Evaluate managed care contracts for financial impact and compliance.
• Develop reimbursement models and simulate contract scenarios.
• Support contract negotiations with data-driven insights.

Financial & Operational Reporting

• Prepare reports on payer performance, reimbursement trends, and variances.
• Monitor KPIs related to managed care and revenue cycle.

Data Management & Analytics

• Extract and analyze data from EMR, billing, claims systems, managed care contract system, AI Denials Management System.
• Identify patterns in denials, underpayments, and delays.

Collaboration & Communication

• Partner with Chief Growth and Strategy Officer and VP Managed Care, Revenue Cycle team, Finance team, Compliance, and Clinical teams.
• Present findings and recommendations to leadership.

Regulatory & Compliance Monitoring

• Stay current with federal/state regulations affecting managed care.
• Ensure contract terms align with regulatory requirements.