Summary:
The Managed Care Contracting Analyst is responsible for financial modeling and economic analysis to support fee-for-service and risk-based contracting strategy, evaluating contract performance, forecasting value-based reimbursement impacts, and identifying optimization opportunities for MyMichigan Collaborative Care Organization (MCCO) and MyMichigan Health. The role collaborates closely with the Managed Care Contracting and Finance teams to inform negotiations and strategic decisions through data-driven insights This role uses tools to generate reports, dashboards and analytical solutions according to business rules and specifications and is responsible for supporting the Managed Care Contracting department through the analysis and review of financial performance of managed care contracts.
Responsibilities:
(50%)* Performs contract analysis and evaluation to assess performance and identify opportunities for MCCO and MyMichigan Health improvement, cost savings, and revenue enhancement. Analyzes and monitors payor trends, managed care contract compliance, contract and payor yield, and indicators that reflect new opportunities for revenue or charge capture that align with MCCO and health system organizational goals. Conduct contract modeling and scenario analysis to assess the impact of proposed contract changes.
(40%)* Responsible for data management and reporting including the collection, validation, and management of data related to managed care contracts. Develops and maintains robust reporting mechanisms to monitor key performance indicators, financial metrics, and contract performance and provides regular reports to MCCO leadership, MyMichigan Health executive leadership, and relevant stakeholders.
(10%)* Support charge master benchmarking and revenue analytics by providing data needed for Finance leaders to make recommendations on MyMichigan Healths strategic pricing.
OTHER DUTIES AND RESPONSIBILITIES:
Collaborate with the contract negotiation team to provide data-driven insights and recommendations during contract negotiations with payers.
Assist in developing negotiation strategies to optimize reimbursement rates and contractual terms.
Work closely with cross-functional teams, including finance, legal, and operational departments, to ensure alignment in contract management strategies.
Collaborate with external stakeholders, such as payers and regulatory bodies, to stay informed about industry trends and changes.
Implement systems for monitoring and tracking key performance indicators related to managed care contracts.
Inform MCCO leaders and teams on payor performance relative to JOC content.
Act as the liaison between Managed Care Contracting, Finance, and IT during the contract build process within the electronic health record by interpreting and applying contract terms and completing post-build audit to validate and ensure accuracy.
Certifications and Licensures:
N/A
Required Education:
Education: Bachelors Degree
Equivalent Experience: Bachelors degree in healthcare administration, business, finance, or a related field required; Associate degree require with relevant Managed Care Contracting experience maybe considered.
Other Information:
EXPERIENCE, TRAINING AND SKILLS:
Minimum of three to five years experience in health care analytics, managed care contracting, or related field.
Experience utilizing and navigating an Electronic Health Record, EPIC is preferred.
Strong interpersonal and organization skills required. Excellent verbal and written communication skills and knowledge regarding health care medical benefits required.
Demonstrate strong project management and orbitational skills.
Excellent understanding of healthcare reimbursement methodologies and managed care principles. Strategic thinking with strong analytical skills.
Contract modeling experience.
Computer knowledge in Windows environment using Word, Excel, Access and PowerPoint, along with SQL and business or population health platforms are also required.
Strong analytical skills, communication skills and organization skills are required.
Possess the ability to work independently and/or in a team to train, guide or assist others to perform complex assignments.
PHYSICAL/MENTAL REQUIREMENTS AND TYPICAL WORKING CONDITIONS:
Exposure to stressful situations, including those involving public contact, as well as, trauma, grief and death.
Able to wear personal protective equipment that includes latex materials or appropriate substitute if required for your position.
Is able to move freely about facility with or without an assisted device and must be able to perform the functions of the job as outlined in the job description.
Overall vision and hearing is necessary with or without assisted device(s).
Frequently required to sit/stand/walk for long periods of time. May require frequent postural changes such as stooping, kneeling or crouching.
Some exposure to blood borne pathogens and other potentially infectious material. Must follow MyMichigan Health bloodborne pathogen and TB testing as required.
Ability to handle multiple tasks, get along with others, work independently, regular and predictable attendance and ability to stay awake.
Overall dexterity is required including handling, reaching, grasping, fingering and feeling. May require repetition of these movements on a regular to frequent basis.
Physical Demand Level: Sedentary. Must be able to occasionally (0-33% of the workday) lift or carry 0-10 lbs.
