Managed Care Contracting Analyst - Remote

The CORE Institute; Phoenix (AZ); À distance; USD 85 000 - 110 000; Plein temps

Résumé du poste

The CORE Institute is seeking a Managed Care Contracting Analyst (Remote) to analyze financial and operational performance of health care contracts, including Medicaid and other managed care products. The role involves creating financial models, monitoring reimbursements, and collaborating with revenue cycle and contracting teams to optimize payor outcomes.

The ideal candidate has at least three years in healthcare analytics, experience with relational databases and decision support systems, and

Qualifications

• Bachelor's degree in Finance or Healthcare Administration preferred.
• Minimum 3 years in analytics within a healthcare setting.
• Experience with revenue cycle and physician reimbursement.

Responsabilités

• Prepare analyses of financial and operational performance of healthcare contracts.
• Analyze Medicaid and other managed care products (HMO, PPO, POS).
• Monitor and trend third party reimbursement and denial analysis.
• Create financial models and reports for existing and new data sources.
• Collaborate across departments to optimize payor reimbursement outcomes.
• Identify trends driving healthcare costs and advise actions to improve financial performance.

Connaissances

Relationship building

Task organization

Multi-tasking

Communication

Analytical thinking

Formation

Bachelor's degree in Finance

Bachelor's degree in Healthcare Administration preferred

High school graduate

Outils

Relational databases

Decision support systems

Analytics software

Description du poste

Managed Care Contracting Analyst - Remote

Job Category : APP

Requisition Number : MANAG012861

• Posted : September 11, 2026
• Full-Time

Locations

Showing 1 location

Description

ESSENTIAL FUNCTIONS:

• Prepare analysis related to the financial and operational performance of health care contracts, including the impact of regulatory rate or other changes and identify the financial and/or operational performance of those agreements. Recommends areas of improvement.
• Provides analysis for Medicaid and other Managed Care products such as HMO, PPOs and POS products.
• Monitor and trend third party reimbursement including denial analysis.
• Create financial models as required to analyze data and report efficiently for existing and new reports.
• Supports Management by providing information, locating data sources and collecting data under tight time constraints.
• Identify and analyze utilization patterns driving health care costs and recommend actions to impact financial performance.
• Reviews all shared risk claims, capitation, risk pool settlements, and various reports submitted by the health plans. Submit shared risk discrepancy reports within the time limits required by each individual health plan and in the format requested by each individual health plan.
• Create various reports regarding payor reimbursement for Senior Leadership.
• Charged with providing recommendations to Revenue Cycle regarding changes in utilization of those applications.
• Create queries to pull financial/claims data that will then be used to develop analytical and statistical models to help customers make informed business decisions.
• Identifies and communicates trends and/or potential issues to management team.
• Serves as the liaison between health plans and revenue cycle.
• Collaborates with Contracting/Credentialing Dept to optimize health payor reimbursement outcomes
• Analyze health payor optimization within each market
• Create and schedule JOCs with each applicable health plan rep for each market
• Updates & Audits Clearwave system to ensure provider information is most current
• Extracts and queries data from multiple sources and systems and compile data in the form of written and verbal reports and presentation.

The job holder must demonstrate current competencies for job position.

EDUCATION:

High school graduate or equivalent. Bachelor's Degree in Finance or Healthcare Administration preferred.

EXPERIENCE:

Must have a minimum of three years' experience working in analytic or analyst role in a healthcare environment with an in depth knowledge of physician reimbursement. Experience in using relational databases, decision support systems, analysis and modeling.

REQUIREMENTS:

Two or more years' experience with Revenue Cycle Billing

KNOWLEDGE:

• Knowledge of the Payor Reimbursement process.
• Knowledge of computer systems.
• Knowledge of Health Plan Billing claim paperwork and timelines.
• Knowledge of Health Plan Billing timelines and regulations.

SKILLS:

• Skill in establishing good working relationships with internal and external customers.
• Skill in organizing daily work assignments for various tasks.
• Skill in managing multiple work assignments and set priorities.

ABILITIES:

• Ability to establish good working relationships with internal and external customers.
• Ability to communicate effectively with staff, leadership, health plan representatives, other depts.
• Ability to be organized and efficient in daily work activities/projects.
• Ability to exercise independent judgment and decision-making abilities.

ENVIRONMENTAL/WORKING CONDITIONS:

Normal office environment.

PHYSICAL/MENTAL DEMANDS:

Requires sitting and standing associated with a normal office environment. Some bending and stretching required. Manual dexterity using a calculator and computer keyboard.

ORGANIZATIONAL REQUIREMENTS:

• CORE Creed must be read and signed.
• OSHA Requirements and training to include: *Safety Training.

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.

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.