The Senior Managed Care Contract Analyst is responsible for analytics, negotiations, and relationship management related to managed care contracts. This role supports senior leadership by conducting complex contract analyses and summarizing financial trends and impacts for the Hospital, the Physicians’ Organization, and the Pediatric Physicians’ Organization at Children’s Hospital (PPOC).
The position analyzes payer contract performance, evaluates reimbursement methodologies, and develops financial models to support contract negotiations and strategic decision-making. The Senior Analyst also coordinates the work of other analysts in preparing contract terms and presenting findings to executive leadership, including both textual contract language and rate sheet structures. In addition, the role oversees auditing schedules, tracking mechanisms, and recovery efforts related to revenue discrepancies, including claim rebilling and settlement opportunities. A strong understanding of payer contracts, reimbursement structures, coverage policies, and authorization requirements is essential.
Key Responsibilities

• Design and develop complex financial models to support reporting, payer negotiations, and contract strategy. Gather and analyze data using internal reporting systems and analytical tools.
• Apply knowledge of hospital and physician reimbursement methodologies, including non–fee-for-service arrangements, to evaluate contract performance and recommend improvements.
• Conduct detailed analyses of commercial and governmental payer contracts to evaluate payment accuracy, completeness, and performance trends. Review patient-level account transactions and identify opportunities for corrective action or revenue recovery.
• Collaborate with internal departments to improve the quality and integrity of payer contract payment collection efforts.
• Maintain and update the Managed Contract System to ensure accurate configuration of commercial and government contracts. Perform testing and validation to confirm proper modeling and system functionality.
• Partner with department managers to interpret financial reports, troubleshoot issues, reconcile balances, and provide written explanations of contract performance and reimbursement outcomes.
• Research and analyze financial data for internal and external stakeholders. Organize and maintain financial data using databases and spreadsheets to support reporting, identify discrepancies, and implement solutions.
• Develop ad hoc financial analyses, reports, and models for senior leadership to support operational and strategic decision-making.
• Provide functional supervision and mentorship to Analyst I and Analyst II staff, including reviewing work for accuracy, sharing expertise, and providing constructive feedback to improve performance.
• Support finance-related committees and participate in departmental initiatives as required. Perform additional duties as assigned.

Education

• Bachelor’s degree in business, Finance, or a closely related field required.
• Degree in Finance, Economics, or Healthcare Administration preferred.
• CPC certification is preferred.

Experience

• Minimum 10 years of physician billing or third-party payer experience required
• Experience with hospital billing and contract agreement analysis
• Strong knowledge of payer reimbursement structures and collections (e.g., BCBS, United Healthcare, Single Case Agreements)
• Epic experience required
• Experian software experience preferred

On-Site Requirement
This position requires on-site presence at least once per month.