Managed Care Contract Analyst

Managed Care Contract Analyst

JOB-10044770

Anticipated Start Date

September 08, 2025

Location

Dallas, TX

Type of Employment

Contract Hire

Employer Info

Our client is one of the largest and most prestigious pediatric health care providers in the country and the leading pediatric health system in North Texas. Their mission is to make life better for children and be committed to the community. In addition to providing health care, they are a leader in life-changing treatments, innovative technology and ground-breaking research, advocacy, education, and preventive care. Many of their roles are temp-to-hire, giving our client and our candidates the opportunity to ensure they are the right fit for a full-time position, as this comes with career advancement opportunities and excellent benefits.

Job Summary

We are looking for individuals to join our client’s team as Managed Care Contract Analyst. This role includes complex data and financial analysis, financial interpretation of contract terms, contract modeling, data validation, developing reimbursement methodologies, maintaining contracts in EPIC and identification of revenue enhancing opportunities. Develop alternative financial proposals that are within the budget parameters, based on analysis and modeling of contract performance by developing and preparing revised models using sound rationale, and present recommendations for Managed Care leadership. Support the organization by providing ad-hoc detailed data reports related to Managed Care agreements and Patient Financial Services activity to internal and external customers.

Job Description

• Collaborate with other departments to prioritize and ensure Managed Care contract performance and all related analytic needs are met for the system. Serve as a mentor to other Analysts on the team and a subject matter expert to other departments.
• Complete financial impact analysis of all contract negotiations, including modeling of contract proposals, reporting of contract proposal impact, performance and quantifying financial impact of these proposals for future year(s) and developing alternative proposals within the budget parameters. Present analysis and recommendations to leadership.
• Prepare multiple analyses and presentations by extracting data from systems including Crystal, EPIC, STRATA and other Company Services systems and relational databases utilizing expertise in Excel. Evaluates the need to create new or modify existing ad hoc and/or customized reports.
• Review all Managed Care contracts and amendments as received and complete require system updates, ensuring that all contracts in EPIC are current and calculating correctly.
• Analyze contracts and prepare all supporting schedules necessary to update/maintain the EPIC system on a current basis. This includes but not limited to: reviewing all new contracts/amendments, meeting with Revenue Cycle staff to review changes, communicating with the payors to receive all updates on the current basis, researching and downloading data form payor sites, analyzing and comparing new fee schedules to the prior fee schedules, preparing all uploads, validating input and updating
• EPIC reimbursement contracts.
• Stay abreast of all Texas Medicaid & Healthcare Partnership (TMHP), CMS and other governmental regulation changes that
• affect Fee Schedule pricing. Proactively model all changes to fee schedules to determine the financial impact on Company revenue and communicate with leadership.
• Accountable for the maintenance of the Payor and Plan database in EPIC. Facilitate monthly meetings and seek agreement before any changes are made. Maintain synchronization among the service areas. Ensure all plans are mapped to the correct contract in EPIC and facilitate audits, at least on a quarterly basis.
• Interprets managed care for contract terms and validates understanding with the contract negotiator and model relevant parameters into contract model application for contracts with annual revenue in excess of $2.3 Billion.
• Accountable for contract model module and/or application, including but not limited to the maintenance of commercial and government Managed Care Organization (MCO) contracts, fee schedules and other tables relating to contract modeling generating annual Company revenue of in excess of $1.5 Billion.
• Actively participates on cross functional teams to identify revenue enhancement opportunities and develop and implement solutions for under-performing facility and professional contracts, including improvements in denials and underpayments.
• Provides necessary reporting and analytics to support the goals of these teams.
• Communicates difficult and/or sensitive and confidential information. Handles confidential material on a regular basis and is responsible for protecting the confidentiality of such information within the established guidelines of Company and law.
• Supports the Senior Director, Managed Care with existing and new projects/initiatives.
• Works in a fast-paced environment with frequently changing priorities.

Skills Required

• At least 5 years’ experience in financial analysis, data mining and reporting required
• Requires depth within a specialized, critical discipline and/or breadth of substantive professional knowledge that crosses disciplines within the professional field
• Interprets internal/external business challenges and recommends best practices to improve products, processes or services
• May lead functional teams or projects with moderate resource requirements, risk, and /or complexity
• Leads others to solve complex problems; use sophisticated analytical thought to exercise judgment and identify innovative solutions
• Impacts the achievement of customer, operational, project or service objectives; work is guided by functional policies
• Works independently, with guidance in only the most complex situations
• Communicates difficult concepts and negotiates with others to adopt a different point of view
• At least 5 years’ experience with hospital billing system, EPIC preferred
• At least 5 years’ experience in healthcare, contract modeling and analysis for facility and professional agreements preferred

Education/Training/Certifications

• Four-year bachelor’s degree or equivalent experience required

Epic certification within one year of hire required:

• HB (Hospital Billing) Resolute Epic Certification
• PB (Professional Billing) Resolute Epic Certification

Additional requirements

• Shift: Monday - Friday 8:30-4:30. We close our department on holidays and do not work weekends.

“We are an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, national or ethnic origin, sex, sexual orientation, gender identity or expression, age, disability, protected veteran status or other characteristics protected by law”.