Senior Managed Care Analyst: Remote Strategic Contract Analytics

SOUTHWESTERN HEALTH RESOURCES HOSPITALS JOC; Dallas (TX); Hybrid; USD 85.000 - 110.000; Vollzeit

Zusammenfassung

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.

Qualifikationen

• 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.

Aufgaben

• 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

Kenntnisse

Decision support

Financial analysis

Healthcare reimbursement

Contract modeling

PMMC Contract Pro

Strata

Ausbildung

Bachelor's Degree Business or related field

Tools

PMMC Contract Pro

Strata

Jobbeschreibung

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.