Manager Managed Care Analytics

Manager Managed Care Contract Analytics Internal Job

Reports to the SVP, Managed Care, the Manager, Managed Care Contract Analytics oversees the data and analytic needs of the Managed Care department including contract modeling and performance, data reporting, and regulatory requirements. This role directly supports department leadership in all payer contract negotiations through EPIC contract modeling, scenario modeling, comparative analysis, and benchmarking. The Manager, Managed Care Contract Analytics also participates in contract negotiations, actively manages financial components of active contracts and provides evaluations alongside key input into the determination of financial strategy for payer proposals.

Assists with complex, advanced evaluations of payer related issues such as policy and coding changes. Transforms claims and clinical data into actionable reports. Completes ad hoc analysis to support business needs. Develops and implements regular, periodic reporting and dashboards. Monitors contract performance and tracks key contract statistics. This role directly contributes to improving pricing accuracy and supporting the overall success of the Managed Care and Contract Management Application Development Teams, collaborating to resolve issues with contract load or calculation mechanics, ensuring alignment with agreed-upon contract terms.

Oversees development and publication of a complaint machine-readable file. Develops and maintains productive relationships with key stakeholders, both internal and external to the organization. Manages a team of analysts and ensures they are trained and have needed resources.

Annual Salary Range: $ - $

• Requires a Bachelor’s Degree in Business, Finance, Health Care Administration, or related field; or an equivalent combination of training and progressively responsible experience that will result in the required specialized knowledge and abilities to perform the assigned work.
• Preferred MBA, MHA or related master's degree.

• Minimum of 7 years of experience with health care, financial analysis and/or managed care contracts including health insurance operations and payment methodologies.
• Preferred minimum 2 years’ management experience.
• Preferred SQL, Tableau, and/or Strata experience.

• Preferred EPIC certification for HB Resolute (Contract Modeling).

• Capacity to effectively interpret managed care contracts and reimbursement structures.
• Must have knowledge of Medicaid system (traditional and managed care), as well as federal Medicare Advantage and commercial health insurance exchange programs. Solid understanding of reimbursement models, ensuring accuracy in pricing and reimbursement projections.
• Working knowledge of billing/coding terminology (i.e. ICD-10, CPT, Revenue codes).
• Proficiency in Microsoft Office Suite required, with advanced knowledge of Excel, (MS SQL is desirable but not required), with the ability to manage, analyze, and interpret large data sets to derive actionable insights.
• Ability to thrive and maintain a high level of performance in a fast-paced, dynamic work environment.
• Strong interpersonal skills, ability to with the ability to present complex data and insights clearly to stakeholders across various departments.
• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses.
• High level of integrity and dependability with a strong sense of urgency and results oriented.
• Excellent written and verbal communication skills required.
• Excellent problem solving and analytical skills.