Managed Care Contracting Analyst

Augusta Health Brand; Fishersville (VA); On-site; USD 38,255 - 58,534; Full time

Job summary

Augusta Health is seeking a Managed Care Contracting Analyst to support the contracting function across hospital, ancillary, and employed physician services. You will develop contract models, run reimbursement analyses, and produce payer performance reporting to inform negotiation strategy and protect long-term sustainability.

The role emphasizes collaboration with Revenue Cycle and other departments in a mission-driven health system.

Qualifications

• Bachelor’s degree in Finance, Accounting, Business Administration, Healthcare Administration, Economics, Mathematics, or related field, or equivalent combination of education and experience.
• Three years of progressive experience in healthcare finance, managed care, revenue cycle, or payer analytics.
• Eligibility to work in the United States and Virginia state employment requirements.
• Experience building financial models and analyses in Excel.

Responsibilities

• Build and maintain financial models of current and proposed payer rates, terms, and payment methodologies.
• Perform what-if modeling of rate proposals, payment methodologies, and utilization scenarios.
• Analyze claims, charge, and reimbursement data to develop payer baselines, trends, and benchmarks.
• Prepare rate comparisons, yield analyses, and payer scorecards for negotiations and executive reporting.
• Support budgeting and forecasting with projected impacts of rate changes and payer mix shifts.
• Monitor executed contracts for variances and pursue recoveries with Revenue Cycle.
• Maintain contract repository and renewal date tracking.
• Prepare materials for payer meetings, negotiations, and executive reporting.
• Ensure data governance and integrity across models and reporting.

Skills

Advanced Excel

Data analysis

Communication

Collaboration

Project management

Education

Bachelor’s degree in Finance, Accounting, Business Administration, Healthcare Administration, Economics, Mathematics, or related field

Master’s degree (MBA, MHA, MSF, or equivalent)

CRCR or CHFP certification

CPA

Tools

Excel

SQL

Power BI

Job description

• Pay or shift range: $27.77 USD to $42.49 USD

  The pay range reflects the current compensation range for this position at the time of posting. Individual offers are determined based on directly related experience, skills, education, internal equity, and other job-related factors. Not all candidates will qualify for the upper end of the posted range.

Description

Overview

At Augusta Health, your work matters — and so do you. Whether you're delivering direct patient care, supporting operations, or innovating behind the scenes, every role contributes to our mission of promoting wellness and healing through compassionate service. We offer more than just a job — we offer a purpose-driven career in a nationally recognized, independent health system located in Virginia’s scenic Shenandoah Valley.

Our team members thrive in a supportive culture that values collaboration, integrity, and excellence. With opportunities across clinical and non-clinical areas, Augusta Health is a place where your skills make a difference, and your growth is a priority.

Why Join Augusta Health?

We believe in taking care of the people who care for our community. That is why Augusta Health offers a comprehensive and thoughtfully designed benefits package that supports your well-being, career development, and work‑life balance. Whether you're launching your career or bringing in years of experience, we provide the tools, resources, and encouragement to help empower you to reach your full potential — personally, professionally, and financially.

Total Rewards & Benefits (may vary by position)

• Comprehensive insurance package including medical, dental, and vision coverage
• Retirement savings plans and financial wellness support programs
• Earned Wage Access Program, allowing eligible team members to access a portion of earned wages before payday
• Generous paid time off and flexible scheduling to promote work‑life balance
• Career development programs including clinical ladders, shared governance, and advancement opportunities
• Personalized onboarding with dedicated preceptors and ongoing educational support
• Tuition reimbursement and access to onsite childcare
• Free onsite parking, 24/7-armed security for your safety, a Health Fitness Reimbursement Program, and an onsite credit union and pharmacy
• Competitive pay with shift/weekend differentials
• Employee discounts at the cafeteria, gift shop, pharmacy, and local entertainment venues (i.e., movie tickets)

The Managed Care Contracting Analyst plays a critical role in supporting Augusta Health’s mission and advancing departmental goals through measurable performance indicators and service excellence. This position contributes to a collaborative, patient‑centered environment and helps drive outcomes aligned with organizational priorities.

Reporting to the Director of Managed Care Contracting, the Managed Care Contracting Analyst provides analytical, financial modeling, and operational support for Augusta Health’s managed care contracting function across hospital, ancillary, and employed physician services.
The Analyst develops contract models, reimbursement analyses, and payer performance reporting that inform negotiation strategy, quantify the financial impact of proposed rates and terms, and support Augusta Health’s long‑term sustainability as an independent community health system.

The Analyst monitors executed contracts on an ongoing basis, identifying payment variances, underpayments, and payer policy changes, and supports the resolution of escalated payer issues in collaboration with Revenue Cycle and other departments.

Working under the direction of the Director, the Analyst also maintains the contract repository, tracks key contract terms and renewal dates, and prepares materials for payer meetings, negotiations, and executive reporting.

• Build and maintain financial models of current and proposed payer rates, terms, and payment methodologies to quantify net revenue impact.
• Perform what-if modeling of alternative rate proposals, payment methodologies, and utilization scenarios in support of negotiation strategy.
• Analyze claims, charge, and reimbursement data to develop payer-specific baselines, trends, and benchmarks.
• Prepare rate comparisons, yield analyses, and payer scorecards for use in negotiations and executive reporting.
• Support budgeting and forecasting with projected impacts of rate changes, payer mix shifts, and new agreements.
• Payer Performance Monitoring
  
  • Monitor executed contracts on an ongoing basis, comparing expected to actual reimbursement and identifying payment variances and underpayments.
  • Research root causes of payment variances and coordinate with Revenue Cycle to pursue recoveries and corrections.
  • Track payer policy changes, fee schedule updates, and contract amendments, and assess their financial and operational impact.
  • Maintain key performance indicators and dashboards for contract yield, payer mix, denials, and payment timeliness.
  • Prepare recurring contract performance reports for the Director, CFO, and other stakeholders.
• Prepare data, models, exhibits, and briefing materials in support of payer negotiations led by the Director.
• Evaluate payer proposals and counterproposals, quantifying financial impact and identifying unfavorable terms.
• Assist in developing negotiation targets, priorities, and renewal calendars for the managed care contract portfolio.
• Support analyses requested by external managed care consultants and advisors, and incorporate their benchmarking into internal work products.
• Attend payer meetings and negotiations as requested, documenting outcomes and follow‑up items.
• Contract Administration & Data Management
  
  • Maintain a centralized repository of executed agreements, amendments, rate exhibits, and key contract terms.
  • Track contract effective dates, renewal dates, termination windows, and notice requirements to prevent lapses or unfavorable auto‑renewals.
  • Summarize key contract provisions and communicate rate and term changes to Revenue Cycle, Patient Access, and other affected departments.
  • Support accurate loading and implementation of contract terms in applicable systems, validating expected reimbursement calculations.
  • Ensure data governance, quality, and integrity standards are maintained across contract models and reporting.
  • Document modeling methodologies, assumptions, and data sources to ensure analyses are reproducible and auditable.
• Issue Resolution & Collaboration
  
  • Research and support resolution of escalated payer issues involving payment promptness, denials, authorizations, credentialing, and payer‑member concerns.
  • Collaborate with Revenue Cycle, Finance, and Population Health to ensure reported data is reliable and issues are addressed timely.
  • Respond to information requests from external auditors, consultants, and payers as directed.
  • Provide analytical support for value‑based care arrangements, including performance tracking against quality and cost targets.
• Maintain current knowledge of federal and state regulations affecting managed care, including CMS requirements, price transparency, and the No Surprises Act.
• Monitor market trends, payer product developments, and competitor activity to inform strategy recommendations.
• Support compliance with contract‑related regulatory reporting and documentation requirements.
• Professional Development & Culture
  
  • Model Augusta Health’s values and contribute to a collaborative, results‑oriented team culture.
  • Pursue continuous learning in managed care, reimbursement, and analytics through professional development opportunities.
  • Identify and recommend process improvements to enhance the accuracy and efficiency of contracting analyses.
  • Participate in professional associations and peer networks related to healthcare finance and managed care as appropriate.

Required Qualifications

• Education: Bachelor’s degree in Finance, Accounting, Business Administration, Healthcare Administration, Economics, Mathematics, or a related field; or an equivalent combination of education and relevant analytical experience
• Licensure/Certification: None
• Experience:
  • Three (3) years of progressive experience in healthcare finance, managed care, revenue cycle, decision support, or payer analytics.
  • Demonstrated experience building financial models and analyses in Excel, including reimbursement, rate, or net revenue modeling.
  • Experience working with healthcare claims, charge, or reimbursement data and interpreting payer contract terms.
  • Demonstrated ability to present analytical findings clearly to non-technical audiences.
• Driver’s License: N/A
• Eligibility to work in the United States and meet Virginia state employment requirements

Preferred Qualifications

• Education:
  • Master’s degree (MBA, MHA, MSF, or equivalent)
  • Coursework or formal training in healthcare finance, statistics, or data analytics
• Licensure/Certification:
  • Certified Revenue Cycle Representative (CRCR) or Certified Healthcare Financial Professional (CHFP) through HFMA
  • Certified Public Accountant (CPA)
  • Lean Six Sigma Green Belt
  • Membership in HFMA or comparable professional associations
• Experience:
  • Experience supporting managed care contract negotiations within a hospital, health system, or payer organization.
  • Experience with contract modeling tools, decision support systems, or healthcare data warehouses (e.g., Meditech Data Repository, SQL, Power BI, or similar).
  • Working knowledge of value‑based care arrangements and alternative payment models.
  • Experience working within an independent community health system or similarly complex healthcare organization.
• Prior experience in a hospital, healthcare system, or related service-oriented environment
• Familiarity with Augusta Health’s systems, workflows, or organizational culture is a plus

Competencies, Knowledge, Skills and Abilities

• Strong knowledge of healthcare reimbursement methodologies, including DRG, per diem, fee schedule, percent‑of‑charge, and value‑based payment models.
• Advanced Excel skills, with the ability to build, maintain, and quality‑check complex contract and reimbursement models.
• Proficiency with data analysis and reporting tools (e.g., SQL, Power BI, or similar) and the ability to work with large claims and charge datasets.
• Strong analytical and critical thinking skills, with attention to detail and a commitment to data accuracy and integrity.
• Ability to read and interpret managed care contract language, rate exhibits, and payer policies.
• Working knowledge of federal and state regulations affecting managed care, including CMS requirements, price transparency, and the No Surprises Act.
• Excellent written and verbal communication skills, with the ability to translate technical analyses into clear recommendations.
• Strong organizational and project management skills, with the ability to manage multiple priorities and deadlines.
• Ability to work collaboratively with Revenue Cycle, Finance, Population Health, and payer representatives to research and resolve issues.
• Ability to handle confidential information with discretion and sound judgment.
• Self‑directed, curious, and committed to continuous learning and process improvement.

About Augusta Health

Augusta Health is an independent, nonprofit, mission‑driven health system located in Fishersville, Virginia, in the heart of the Shenandoah Valley. We offer a full continuum of inpatient and outpatient services, including Augusta Medical Center—a 255‑bed facility and Augusta Medical Group, which operates 40 practice locations and four urgent care centers. Our commitment to excellence, innovation, and compassionate care makes Augusta Health a leading employer and healthcare provider in the region.

Discover more about our history, values, and community impact on our About Us Page.

Equal Opportunity Statement

Augusta Health recruits, hires, and promotes qualified candidates for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran or military discharge status, and family medical or genetic information.

We are committed to fostering a diverse and inclusive workplace in accordance with federal and Virginia state employment laws.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.