Job Overview:
The Managed Care Analytics Coordinator supports managed care contracting, payer relations, reimbursement analysis, and revenue cycle activities across the organization. This position is responsible for maintaining contract and fee schedule information, monitoring payer performance, researching reimbursement issues, identifying reimbursement opportunities, and supporting reporting and analysis related to managed care and revenue cycle operations.The ideal candidate will have experience in managed care, healthcare reimbursement, and revenue cycle operations, preferably within Ambulatory Surgery Center (ASC) and Hospital Outpatient Department (HOPD) settings. Advanced Microsoft Excel skills are required, including experience with pivot tables, formulas, data analysis, and managing large datasets. Experience using Microsoft Power BI or similar reporting tools to create dashboards and reports is preferred. Experience extracting and analyzing data from patient accounting and EMR systems, such as HST Pathways, Epic, and similar healthcare platforms, is a plus.The successful candidate will be organized, detail-oriented, and able to manage multiple priorities while maintaining accuracy and deadlines. The candidate should be comfortable working with data, contract information, and supporting cross-functional teams.
General Requirements
· Knowledge of managed care contracting, payer reimbursement methodologies, and healthcare revenue cycle operations.
· Strong analytical skills with the ability to interpret financial, operational, and payer data.
· Advanced proficiency with Microsoft Excel, including pivot tables, formulas, data validation, lookups, and data analysis functions.
· Experience creating dashboards, reports, and data visualizations using Microsoft Power BI or similar business intelligence platforms.
· Ability to analyze large datasets, identify trends, and communicate findings to operational stakeholders.
· Excellent written and verbal communication skills with a professional approach.
· Ability to work independently while effectively collaborating within a cross-functional team environment.
· Strong organizational skills with the ability to manage multiple priorities, meet deadlines, and maintain accuracy under pressure.
· Ability to promote teamwork, accountability, and continuous improvement.
· Regular work attendance.
Job Duties and Responsibilities
Managed Care Contracting andRCM Optimization
· Establish payer relationships, subscribe to payer newsletters/bulletins in order to keep Revenue Cycle and Managed Care team apprised of network policy changes, etc.
· Ensure loading of contractual information, including payor fee schedules, crosswalks, and rate increases into shared sites & software, as well as contract routing for signature process, logging & tracking.
· Provide procedure pricing for all facilities.
· Develop and maintain contracting tools for use by Business Office staff to include summary of contracts, applicable fee schedules, grouper listings, etc. on SharePoint.
· Research and update state and federal fee schedules for loading into all systems, as needed.
· Investigate and assist in contract reimbursement issues.
· Maintain and update payor mapping to connect contract data with patient accounting data.
· Perform Single Case Agreement reviews.
· CDM pricing updates annually & as needed provided to Revenue Cycle & Price Transparency Tool.
· Loads contracts and other key documentation into appropriate systems (i.e., SharePoint, Cabinet).
· Respond to questions from sites and billing teams on contract/reimbursement issues.
· Additional duties as assigned within Managed Care.
Healthcare Data Analytics & Reporting
- Extract, analyze, and interpret healthcare data from multiple systems including HST Pathways, EPIC, patient accounting platforms, payer systems, and internal reporting tools.
- Develop recurring reports and dashboards to monitor:
- payer performance
- reimbursement trends
- payment variance
- revenue opportunities
- operational performance
- Perform data validation, reconciliation, and quality checks to ensure reporting accuracy.
- Translate data into meaningful insights for leadership and operational teams.
· Analyzes facility and payer data for new and current service lines for reimbursement opportunities.
· Support development of standardized reporting tools and analytics processes.
Technology & Analytics
- Microsoft Power BI
- Build and maintain dashboards and reporting tools
- Create KPI visualizations and performance scorecards
- Analyze payer trends, reimbursement performance, and revenue opportunities
- Develop automated reporting solutions to support leadership decision-making
- Microsoft Excel (Advanced)
- Pivot tables
- Advanced formulas and functions
- Data modeling
- Large dataset management
Work Experience Requirement
2–4 years of experience in healthcare, preferably in managed care, revenue cycle management, or a related field. Advanced proficiency in Microsoft Excel, including experience working with large datasets, data analysis, and reporting. Experience in using Microsoft Power BI or similar business intelligence/reporting tools to develop dashboards and reports. Strong verbal and written communication skills with the ability to present data-driven insights effectively. Demonstrated ability to work collaboratively in a team-oriented environment. Experience with SharePoint is preferred.
Education Requirement
High School Diploma or equivalent, post-secondary education preferred.
Pay: $25.00 - $32.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Work Location: Remote
