Reporting to the Provider Network Contracts Manager, the Managed Care Contract Analyst compiles, validates, and analyzes healthcare cost, quality and utilization data to aid in contract negotiations as well as contract performance and network enhancement initiatives. In addition to gathering volume data and modeling of current reimbursement, the Managed Care Contract Analyst determines the need for reimbursement methodology changes and proposes target rates. Provides high level analysis to support the organization's strategic goals and objectives.

Responsibilities include:

Provides support for special projects, which includes collecting, analyzing and modeling of claim data in preparation for payer contract negotiations. Prepares and analyzes physician practice reimbursement utilizing appropriate rates based on contract structure, place of service, provider and modifiers for each CPT code. Calculates Medicare reimbursement and compares to payer reimbursement for same volume.

Build financial and statistical models, analyze data, and translate analysis into specific, targeted action to drive results. Extract, compile, and format data to produce a variety of reports and presentations to management and executive leadership.

In collaboration with Network Contracts Manager, responsible for all aspects of Provider Negotiations including contract language review to negotiate language with providers to ensure favorable terms. Responsible for Contract Finalization and Implementation including the review of final documents to ensure accuracy upon agreement terms, return of countersigned documents to provider, communication of any pertinent changes throughout the system, and an audit of the contract build 3 months post implementation. Negotiates single case agreements for all entities as needed. Logs single case agreement and communicates such agreement to appropriate staff.

Independently analyzes, researches, and recommends resolution for contract disputes, non-routine claim issues, billing questions, and other practices. Communicates and assists with identification and implementation of issue resolution. Ensures issues are handled appropriately and professionally in accordance with payor and regulatory requirements. Data extraction for various reports and analyses upon request.

Works independently on multiple tasks, sets priorities, and develops comprehensive timetables and strategies to meet numerous and constantly changing deadlines. Leads Contract Implementation Workgroup. Collaborates with Network Contracts Manager to build and maintain cost effective, accessible provider network. Manages and maintains provider contracting database to ensure current, accurate ancillary, facility, and physician demographics and contract detail, and initiates database improvements.

• Six (6) years of related experience, education/training, OR a Bachelor's degree in related area plus two (2) years of related experience/training. Related experience: Negotiating/executing Managed Care provider/ancillary/facility contracts. Experience in Provider Relations and some credentialing. Experience with claims adjudication.

• Experience and proven success in managed care contracting, contract review, tracking, and maintenance.

• Experience in Managed Care, Provider Relations, provider office administration, or claims analysis.

• Asana and programming experience.

• Proficiency with MS Office (Excel, PowerPoint, Word) required. Knowledge of Excel, including VLookups and Pivot Tables.

• Demonstrates analytical, problem solving, and critical thinking skills.

• Strong organizational and written/oral communication skills.

• Ability to work in a fast paced and changing environment. Excellent ability to manage to deadlines.

• Must be able to work various hours and locations based on business needs.

• Employment is subject to a criminal background check and pre-employment physical.