Managed Care Analyst

Responsibilities

• Epic Contract Management (30%)
  • Build, test, implement, and maintain complex contracts within Epic Contract Maintenance to support accurate expected reimbursement calculations across all payer systems.
  • Develop and configure advanced HB and PB contract rules, components, and extensions to ensure precise payment modeling across multiple service lines.
  • Perform Epic system build and maintenance within Hyperdrive, Text, PJX/SUP, REL, and Data Courier environments.
  • Participate in Epic system upgrades, testing, and enhancement activities to maintain system performance and functionality.
  • Maintain Epic certification(s) and actively pursue continuous improvement of technical and analytical proficiency.
• Analysis & Data Management (35%)
  • Produce high-quality, accurate qualitative and quantitative analyses to support revenue cycle, financial performance, reimbursement, and managed care contract functions.
  • Conduct in-depth analyses of contract performance, payer trends, denials, and regulatory impacts to identify root causes and improvement opportunities.
  • Ensure all analytical deliverables provide meaningful interpretation, clear presentation, and actionable insights.
  • Design and develop innovative reports, dashboards, and data visualizations using tools such as Epic, Business Objects (Webi/SAP Universes), StrataJazz, Power BI, and Excel.
  • Develop scalable, self-service reporting solutions that empower stakeholders to make data-driven decisions.
• Epic Contract Modeling (25%)
  • Interpret managed care contract and policy language to accurately model and operationalize payment terms within Epic.
  • Evaluate payer reimbursement methodologies (CPT, HCPCS, MSDRG, APC, ICD-10, etc.) and assess related financial impacts.
  • Monitor and analyze managed care contract performance for compliance, accuracy, and reimbursement optimization.
  • Maintain up-to-date knowledge of third-party reimbursement regulations, including Medicare, Medicaid, Medicare Advantage, and commercial payers.
  • Identify and communicate revenue opportunities, risk areas, and cost-saving initiatives based on contract performance analyses.
• Customer Service & Collaboration (10%)
  • Engage with internal customers through regular meetings, clear documentation of requirements, and timely delivery of results.
  • Communicate technical and analytical findings in a clear, concise manner tailored to non-technical audiences and leadership.
  • Collaborate effectively with Patient Access, Financial Services, Managed Care, Information Technology, and Revenue Cycle teams to support organizational goals.
  • Maintain open, proactive, and professional communication channels with all stakeholders before, during, and after project deliverables.
  • Actively participate in cross-functional training and knowledge sharing to enhance team expertise in Epic contract modeling and reporting tools.
  • Develop, maintain, and continuously improve internal documentation, workflows, and best practice guides for Epic contract and reporting functions.
  • Collaborate with IT, Revenue Cycle, and operational teams to optimize Epic contract workflows, streamline processes, and ensure data integrity.

Qualifications

• Required: Bachelor's Degree in Business Administration, Healthcare Management, Hospital Administration, Finance, Statistics, Economics, Industrial Engineering, Information Services or other related fields.
• PREFERRED: Master's Degree in Business Administration, Healthcare Management, Hospital Administration, Finance, Statistics, or related field.