Senior Managed Care Analyst

SOUTHWESTERN HEALTH RESOURCES HOSPITALS JOC; Dallas (TX); Híbrido; USD 85.000 - 110.000; Jornada completa

Descripción de la vacante

Southwestern Health Resources is seeking a Senior Managed Care Analyst to analyze hospital and ASC claims, payments, and reimbursement trends, supporting payer performance assessments. You will drive contract-related analytics, monitoring, and reporting to inform negotiations and financial decisions.

The role emphasizes cross-functional collaboration, data-driven improvements, and strategic payor initiatives, with a mix of remote work and occasional onsite requirements.

Formación

• 5 Years Decision support or financial analysis within the healthcare industry, including contract reimbursement modeling.
• 3 Years Experience in a managed care team utilizing contract modeling platforms such as PMMC Contract Pro, Strata, or similar software.

Responsabilidades

• Analyze hospital and ASC claims, payments, contractual allowances, and reimbursement trends to evaluate payer performance.
• Support continuous improvement of operational efficiencies of the agreements during the term of the contracts by monitoring and comparing estimated reimbursement to actual payments. Work with CBO on payment issues and attend JOC meetings.
• Produce recurring and ad hoc financial reports, dashboards, and executive summaries supporting contract negotiations and operational decision-making.
• Provide analysis and recommendations around service line pricing and margins using market research.
• Assist Managed Care Contracting during contract negotiations by providing analytics in support of strategic payor initiatives.
• Participate in special projects involving reimbursement optimization, contract implementation, and financial performance improvement.
• Coordinate the loading and accuracy of facility and physician managed care contracts with SaaS vendor

Conocimientos

Decision support

Financial analysis

Healthcare reimbursement

Contract modeling

PMMC Contract Pro

Strata

Educación

Bachelor's Degree Business or related field

Herramientas

PMMC Contract Pro

Strata

Descripción del empleo

Senior Managed Care Analyst - Southwestern Health Resources

Southwestern Health Resources is looking for a highly skilled Payor Analyst. Is that you?

Work Hours: Full Time Days (8:00am-5:00pm) for 40 hrs/week (remote work allowed at manager's discretion)

1 day a week onsite required

Department Highlights:

• Remote Position
• Gain a sense of accomplishment by contributing to a teamwork environment.
• Receive excellent mentorship, comprehensive training, and dedicated leadership resources.
• Contribute and work on a cross functional team

What You Will Do:

Analyze hospital and ASC claims, payments, contractual allowances, and reimbursement trends to evaluate payer performance. 30%

Support continuous improvement of operational efficiencies of the agreements during the term of the contracts by monitoring and comparing estimated reimbursement to actual payments. Work with CBO on payment issues and attend JOC meetings. 15%

Produce recurring and ad hoc financial reports, dashboards, and executive summaries supporting contract negotiations and operational decision-making. 10%

Provide analysis and recommendations around service line pricing and margins using market research. 10%

Assist Managed Care Contracting during contract negotiations by providing analytics in support of strategic payor initiatives. 10%

Participate in special projects involving reimbursement optimization, contract implementation, and financial performance improvement. 15%

Coordinate the loading and accuracy of facility and physician managed care contracts with SaaS vendor

10%

What You Need:

Education

Bachelor's Degree Business or related field Req

Experience

5 Years Decision support or financial analysis within the healthcare industry, including contract reimbursement modeling. Req

3 Years Experience in a managed care team that utilzes contract modeling platforms such as PMMC Contract Pro, Strata, or similar healthcare reimbursement software.