Managed Care Operations Analyst/Expert | Hybrid

Proselect Inc; Pasay; On-site; PHP 300,000 - 420,000; Full time

Job summary

Proselect Inc. is seeking a detail-oriented professional to review and maintain managed care contracts, payer policies, and fee schedules.

You will analyze reimbursement issues, claim denials, and payment discrepancies while researching payer requirements and preparing contract summaries for leadership review. The role involves supporting contract administration, database maintenance, and collaboration with internal teams and payers to resolve reimbursement and operational issues.

Qualifications

• Bachelor's degree in Business, Finance, Healthcare Administration, Information Systems, or a related field.
• At least 1 year of experience in managed care, revenue cycle, reimbursement, claims, healthcare operations, or a related healthcare environment.
• Knowledge of healthcare claims processing, reimbursement methodologies, payer policies, and managed care operations.
• Strong analytical, problem-solving, and organizational skills.
• Proficient in Microsoft Office applications, particularly Excel.
• Experience working with hospitals, healthcare providers, payers, HMOs, or healthcare consulting organizations is preferred.

Responsibilities

• Review and maintain managed care contracts, payer policies, and fee schedules.
• Analyze reimbursement issues, claim denials, and payment discrepancies.
• Conduct research on payer requirements and prepare contract summaries and reports.
• Support contract administration, database maintenance, and document tracking.
• Collaborate with internal teams and payers to resolve reimbursement and operational issues.
• Monitor payer policy changes and assist with financial impact assessments.
• Prepare reports and documentation for leadership review.

Skills

Analytical thinking

Problem-solving

Organizational skills

Healthcare claims knowledge

Reimbursement methodologies

Education

Bachelor's degree

Tools

Microsoft Excel

Job description

Review and maintain managed care contracts, payer policies, and fee schedules.

Analyze reimbursement issues, claim denials, and payment discrepancies.

Conduct research on payer requirements and prepare contract summaries and reports.

Support contract administration, database maintenance, and document tracking.

Collaborate with internal teams and payers to resolve reimbursement and operational issues.

Monitor payer policy changes and assist with financial impact assessments.

Prepare reports and documentation for leadership review.

Qualifications:

Bachelor's degree in Business, Finance, Healthcare Administration, Information Systems, or a related field. At least 1 year of experience in managed care, revenue cycle, reimbursement, claims, healthcare operations, or a related healthcare environment.

Knowledge of healthcare claims processing, reimbursement methodologies, payer policies, and managed care operations.

Strong analytical, problem-solving, and organizational skills.

Proficient in Microsoft Office applications, particularly Excel.

Experience working with hospitals, healthcare providers, payers, HMOs, or healthcare consulting organizations is preferred.