Primary Function / General Purpose of Position

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

Essential Job Functions

• Review managed care contracts to ensure alignment with organizational standards, regulatory requirements, and approved contract language frameworks.
• Maintain the contract repository database, ensuring accuracy of contract records, executed agreements, timelines, and updates; serve as internal liaison for system updates and user support.
• Track and document contract terms, reimbursement methodologies, and payer policies; prepare summary analyses for managed care leadership.
• Respond to internal inquiries regarding contract provisions, reimbursement terms, and payer requirements through research and detailed analysis.
• Maintain a comprehensive inventory of payer contracts, fee schedules, and associated policies to ensure operational visibility and consistency.
• Prepare routine and ad hoc reports to provide leadership insight into contract performance, fee schedules, and reimbursement trends.
• Monitor, document, and communicate payer policy changes; support formal reviews to assess operational and financial impact.
• Partner with Revenue Analytics to conduct financial assessments, including fee schedule analysis and reimbursement validation.
• Investigate, document, and assist in resolving claims and reimbursement issues; serve as liaison with payers to facilitate issue resolution.
• Maintain an accurate list of participating payers and manage communication flows regarding payer updates to relevant internal departments.
• Draft routine correspondence to payers related to contract compliance, documentation requests, and dispute initiation under leadership guidance.
• Support dispute resolution workflows, including documentation gathering, issue tracking, and stakeholder coordination.
• Identify and recommend process improvements to enhance efficiency, accuracy, and standardization of contract maintenance and payer policy review processes.

Work Experience

Minimum of 1 year of experience in an acute care facility’s managed care department, for a payer organization, or related healthcare consulting experience (Required)

Experience supporting analytics, reporting, contracting, claims resolution, and/or payer relations (Preferred)

Experience with SQL, Crystal Reports, or similar reporting tools (Preferred)

Experience with contract management systems (e.g., MediTract, nThrive, Symplr), Epic, and third-party payer portals (Preferred)

Understanding of managed care contract language, claims processing, reimbursement methodologies, and regulatory requirements

Demonstrated project coordination experience within a healthcare or health system environment