Job Description

The Managed Care Operations Analyst supports managed care contract operations and compliance activities to ensure accurate reimbursement and adherence to payor agreements. This role is responsible for operational contract administration, fee schedule maintenance, policy documentation, and analytic support, providing insight and escalation support to managed care leadership.

KEY RESPONSIBILITIES

You will:

• Review managed care contracts to support alignment with organizational standards, regulatory requirements, and approved contract language frameworks.
• Maintains the contact repository database, ensuring all information is accurate and timelines are adhered to following execution. Internal liaison for database updates, modifications and training for contracting staff, track and document contract terms and conditions and payer policies by conducting research and preparing summary analyses for managed care leadership.
• Respond to internal requests regarding contract terms and conditions by conducting research and preparing summary analysis for managed care leadership.
• Maintain a comprehensive and accurate inventory of payer contracts, fee schedules, and associated payer policies, supporting visibility and operational consistency.  Prepare routine reports and summaries to support leadership visibility into contract terms and fee schedules by payer.
• Monitor, document, and communicate changes to payer policies. Supports the development and execution of formal reviews of payer policies to determine financial impact. Works with Revenue Analytics to prepare and execute financial assessments, including fee schedule analysis.
• Investigate, document, track, and assist with claims resolution. Act as a liaison for reimbursement issues with payers. Facilitating problem resolution and processing reports as needed to support education on payer requirements. 
• Maintain an accurate list of participating payers. Managing flow of information to and from internal departments to ensure communication regarding Plans changes and updates for use in health system external and patient communications.  
• Draft routine correspondence and notices to payers regarding contract compliance, documentation requests, or disputes initiation under leadership direction.
• Coordinate with managed care leadership and related stakeholders to support dispute resolution workflows, including documentation gathering and issue tracking.
• Identify opportunities to improve efficiency, accuracy, and standardization of contract maintenance, payer policy review, and notifications in collaboration with managed care leadership to streamline and enhance contracting processes

QUALIFICATIONS:

• At least 2 years of experience working in an acute care facility’s managed care department or for a payor, or a combination of related consulting experience.
• Experience in credentialing or supporting analytics, reporting, contracting, claims resolution and/or payer relations
• Experience with SQL, Crystal Reports, or similar reporting tools
• Experience with contract management systems (e.g., MediTract, nThrive, or Symplr), epic, and accessing third party portals. (preferred)
• Proven experience in project management, preferably within a health system.
• Understanding of managed care contract language, claims processing, payer policies, and regulatory requirements.
• Proficiency in using project management tools, expert knowledge level of Microsoft Suite products (Word, Excel, PowerPoint, Outlook, Visio).

Work Schedule: 5 days a week

Shift Schedule: Mid-shift | Hybrid

Location: BGC