Job Description

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POSITION SUMMARY

The Revenue and Managed Care Analyst plays a key role in supporting the financial performance of the hospital by analyzing managed care contracts, payer reimbursement trends, and revenue cycle performance metrics. The Analyst supports the mission of the community safety net hospital by ensuring accurate reimbursement from managed care payers, particularly Medicaid and other government programs. This role is critical in analyzing payer performance, optimizing managed care contracts, and improving revenue cycle operations to sustain care for underserved and vulnerable populations.

ESSENTIAL DUTIES AND RESPONSIBILITIES

1. Analyze managed care contracts to assess payment methodologies, reimbursement structures, and contract compliance.
2. Assist in financial impact analysis to support payer negotiations and renewals.
3. Review proposed contract terms for financial feasibility and alignment with hospital revenue goals.
4. Investigate and resolve payer-related issues that impact accounts receivable, including payment variances and delays.
5. Monitor and identify trends in payer behavior that may affect the hospital's financial sustainability, especially with Medicaid and local health plans.
6. Collaborate with billing, coding, and denial management teams to research root causes and recommend solutions.
7. Act as a liaison between revenue cycle operations, managed care contracting, finance, and patient financial services and collaborate to resolve complex payer issues.
8. Participate in cross-functional meetings to improve payer relationships and revenue performance (Joint Operations Comittiee- JOC)
9. Partner with finance and billing vendors to ensure contract terms are accurately reflected in vendor's billing systems.
10. Communicate findings, insights, and recommendations clearly to both technical and non-technical stakeholders.
11. Other duties as assigned

POSITION REQUIREMENTS

A. Education

• Bachelor's degree in Healthcare Administration, Finance, Business, or related field required; Master's degree preferred.

B. Qualifications/Experience

• Minimum 3-5 years of experience in healthcare revenue cycle, payer analysis, or managed care analytics in a hospital setting.
• Experience with claims analysis, and payer reimbursement methodologies.

C. Special Skills/Knowledge

• Proficient in hospital billing systems (e.g., Cerner) and data tools (Excel, Word, etc)
• Knowledge and understanding of DRG, APC, CPT, ICD-10, and revenue codes.
• Knowledge of Medicare/Medicaid and commercial payer billing regulations.
• Analytical mindset with attention to detail and problem-solving ability.

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Job Tags

Full time, Contract work, Local area,

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