Managed Care Ops Analyst

Nezda Technologies, Inc.; Taguig; Hybrid; PHP 360,000 - 600,000; Full time

Job summary

Nezda Technologies, Inc. is seeking a Contract Specialist to support managed care contract review and policy analyses. You will track terms, maintain payer contract inventories, and prepare summaries for leadership, ensuring accuracy and regulatory alignment.

The role requires cross-functional collaboration and strong attention to detail. Experience in acute care or payer environments and proficiency with Microsoft Office are valued as you coordinate with contracting staff and leadership to

Qualifications

• Bachelor’s degree in information systems, business administration, finance, accounting, or related discipline.
• 1+ years of experience in an acute care facility’s managed care department or for a payer, or related consulting experience.
• Proven experience in project management within a health system.
• Understanding of managed care contract language, claims processing, payer policies, and regulatory requirements.
• Proficiency in using project management tools and Microsoft Office Suite.
• Ability to build effective relationships with diverse stakeholders.
• Strong analytical skills, problem-solving, and attention to detail.

Responsibilities

• Review managed care contracts to ensure alignment with standards and regulatory requirements.
• Maintain the contact repository and ensure information is accurate with timelines.
• Track contract terms and payer policies; prepare summary analyses for leadership.
• Respond to internal requests regarding contract terms with analyses.
• Maintain an inventory of payer contracts, fee schedules, and policies; prepare routine reports.
• Monitor changes to payer policies and aid financial impact assessments with leadership.

Skills

Project management

Analytical skills

Stakeholder management

Attention to detail

Communication

MS Office

Health policy knowledge

Education

Bachelor's degree in information systems, business administration, finance, accounting, or related

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Outlook

Visio

Job description

• Review managed care contracts to support alignment with organizational standards, regulatory requirements, and approved contract language frameworks.
• Maintains the contact repository database, ensuring all information is accurate and timelines are adhered to following execution. Internal liaison for database updates, modifications and training for contracting staff.
• Track and document contract terms and conditions and payer policies by conducting research and preparing summary analyses for managed care leadership.
• Respond to internal requests regarding contract terms and conditions by conducting research and preparing summary analyses for managed care leadership.
• Maintain a comprehensive and accurate inventory of payer contracts, fee schedules, and associated payer policies, supporting visibility and operational consistency. Prepare routine reports and summaries to support leadership visibility into contract terms and fee schedules by payer.
• Monitor, document, and communicate changes to payer policies. Supports the development and execution of formal reviews of payer policies to determine financial impact. Works with Revenue Analytics to prepare and execute financial assessments, including fee schedule analysis.
• Investigate, document, track, and assist with claims resolution. Act as a liaison for reimbursement issues with payers. Facilitating problem resolution and processing reports as needed to support education on payer requirements.
• Maintain an accurate list of participating payers. Managing flow of information to and from internal departments to ensure communication regarding Plans changes and updates for use in health system external and patient communications.
• Draft routine correspondence and notices to payers regarding contract compliance, documentation requests, or disputes initiation under leadership direction.
• Coordinate with managed care leadership and related stakeholders to support dispute resolution workflows, including documentation gathering and issue tracking.
• Identify opportunities to improve efficiency, accuracy, and standardization of contract maintenance, payer policy review, and notifications in collaboration with managed care leadership to streamline and enhance contracting processes.

Qualifications:

• Bachelor’s degree in information systems, business administration, finance, accounting, or a related discipline.
• 1+ years of experience working in an acute care facility’s managed care department or for a payor, or a combination of related consulting experience.
• Proven experience in project management, preferably within a health system.
• Understanding of managed care contract language, claims processing, payer policies, and regulatory requirements
• Proficiency in using project management tools, expert knowledge level of Microsoft Suite products (Word, Excel, PowerPoint, Outlook, Visio).
• Ability to build effective relationships with diverse stakeholders.
• Strong analytical skills, effective problem-solving, and attention to detail.