Job Description
Position Summary
The Managed Care Contract Analyst I develops financial models to support payer contract negotiations and optimize payer performance and reimbursement outcomes. Analyzes financial and reimbursement data and delivers payer contract performance reporting that informs decision-making for leadership, committees, and stakeholders including Boston Children’s Hospital, Physicians Organization, Pediatric Physicians' Organization at Children's (PPOC), and Boston Children’s Health Physicians (BCHP). Coordinates with team members to maintain accurate contract configuration in the organization’s decision support system and develops and distributes payer fee schedules to internal clients. Consistently follows established procedures for file organization, formatting, and data accuracy. Builds on expertise in payer contracts, reimbursement methodologies, insurance and provider market dynamics, and healthcare financial analysis.
Key Responsibilities
The Managed Care Contract Analyst I develops financial models to support payer contract negotiations and optimize payer performance and reimbursement outcomes. Analyzes financial and reimbursement data and delivers payer contract performance reporting that informs decision-making for leadership, committees, and stakeholders including Boston Children’s Hospital, Physicians Organization, Pediatric Physicians' Organization at Children's (PPOC), and Boston Children’s Health Physicians (BCHP). Coordinates with team members to maintain accurate contract configuration in the organization’s decision support system and develops and distributes payer fee schedules to internal clients. Consistently follows established procedures for file organization, formatting, and data accuracy. Builds on expertise in payer contracts, reimbursement methodologies, insurance and provider market dynamics, and healthcare financial analysis.
Key Responsibilities
- Designs and builds simple financial models to support various reporting and contracting needs. Works with other departments within the organization and leverages internal reporting systems to gather and compile the required data.
- Employs basic understanding of Hospital/physician contractual reimbursement methodologies. Prepares appropriate analyses for review by various committees and senior leadership.
- Prepares monthly, quarterly and yearly payer contract performance reports and presents performance trends at the department all staff meeting. Prepares and distributes monthly reports for financial close processes, consistently following established procedures for formatting and accuracy.
- Maintains and updates the Managed Contract System based on commercial and governmental contracts. Performs system set up and testing as necessary to ensure contracts are accurately configured and modeled.
- Compiles quarterly and annual Hospital/physician fee schedules as required by payer contracts. Distributes fee schedules to internal and external clients as needed. Maintains organized and well‑documented project files.
- Research and analyze financial data for internal and external clients. Creates, organizes, and maintains files using database and spreadsheet programs; retrieves and organizes data into required reporting formats.
- Develops, prepares, and presents a variety of ad-hoc reporting, financial models and analyses as requested.
- Provides functional support to Analyst II and Senior Analyst for various projects as needed. Leverages Analyst II and Senior Analyst for shared knowledge and expertise. Provides constructive feedback to colleagues in a timely manner to improve output.
- Perform other tasks as assigned.
- Staffs finance-related Committees, as required.
- Analytical and problem-solving skills: collect information from multiple sources, check information for reasonability, and identify conflicting information.
- A willingness and ability to learn about healthcare data sets and data systems, financial reporting processes, and external market dynamics.
- Organization and documentation of variables, assumptions, and data sources.
- Ability to follow standardized processes accurately and consistently.
- Familiarity with MS Office applications, particularly Excel. Technical skills to execute common Excel formulas (sum, if, Vlookup, pivot tables).
- Ability to communicate effectively both orally and in writing and provide empathy in difficult interpersonal situations.
- Bachelor’s Degree required
- Area of study: Business/Finance or a closely related field required
Numbers & Facts
| Location | Boston, MA |
Skills
- Accounting Closeunmatched
- Ad Hoc Financial Modelingunmatched
- Analysis Skillsunmatched
- Communication Skillsunmatched
- Contract Analysisunmatched
- Contract Managementunmatched
- Contract Negotiationunmatched
- Data Collectionunmatched
- Data Formatsunmatched
- Data Qualityunmatched
- Data Setsunmatched
- Database Administrationunmatched
- Decision Supportunmatched
- Fee Scheduleunmatched
- File Maintenanceunmatched
- Financeunmatched
- Financial Analysisunmatched
- Financial Modelingunmatched
- Financial Reportingunmatched
- Functional Analysisunmatched
- Government Contractsunmatched
- Healthcareunmatched
- Healthcare Reimbursementunmatched
- Hospitalunmatched
- Insuranceunmatched
- Interpersonal Skillsunmatched
- Leadershipunmatched
- Managed Careunmatched
- Microsoft Officeunmatched
- Organizational Skillsunmatched
- Pediatricsunmatched
- Performance Analysisunmatched
- Performance Tuning/Optimizationunmatched
- Pivot Tablesunmatched
- Presentation/Verbal Skillsunmatched
- Problem Solving Skillsunmatched
- Procedure Developmentunmatched
- Productivity Managementunmatched
- Reimbursementunmatched
- Spreadsheetsunmatched
- Systems Administration/Managementunmatched
- Testingunmatched
- Time Managementunmatched
- Trend Analysisunmatched
- Vlookupsunmatched
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