Managed Care Performance Analyst, Full Time, First Shift

Job description

Under minimal supervision, the Managed Care Performance Analyst evaluates financial, operational, and contractual performance across UC Health commercial and government payer agreements. The analyst interprets reimbursement terms, models contracted rate changes, validates expected versus actual payments, and analyzes underpayments, denials, utilization, and net revenue trends to identify financial exposure and recovery opportunities. This role monitors payer compliance with contract requirements, supports issue escalation and resolution, and develops defensible analyses for negotiations, amendments, and operational improvement. The analyst collaborates with Managed Care, Finance, Revenue Cycle, Contracting, Clinical Operations, and payer representatives to deliver actionable performance reporting and recommendations to leadership.
1 Job Function: Payer Contract Performance & Reimbursement Analytics
• Analyzes reimbursement performance for assigned commercial, Medicare Advantage, Medicaid managed care, and other payer contracts using contract terms, fee schedules, claims, remittances, and financial data.
• Validates expected versus actual reimbursement for inpatient, outpatient, professional, and specialty services; identifies underpayments, payment methodology errors, and unfavorable contract performance.
• Models financial impact of proposed rate changes, amendments, service-line provisions, stop-loss terms, and payer policy changes; develops contract-level forecasts and scenario analyses.
• Identifies trends in net revenue, yield, case mix, utilization, and payer performance and quantifies financial opportunity or exposure.

2 Job Function: Claims Denial, Underpayment & Payer Issue Analysis
• Analyzes payer denial, downgrade, recoupment, payment variance, and appeal patterns to identify systemic reimbursement issues and root causes.
• Quantifies affected claims, reimbursement shortfalls, recovery opportunities, and operational impact to prioritize payer escalations.
• Partners with Revenue Cycle and payer contacts to validate issues, develop evidence-based dispute analyses, track corrective action, and measure resolution outcomes.
• Monitors payer adherence to contractual claims processing, appeals, audit, and payment provisions; escalates material trends to Managed Care leadership.

3 Job Function: Contract Compliance & Payer Accountability
• Monitors payer compliance with executed agreements, reimbursement appendices, administrative requirements, performance commitments, and service-level provisions.
• Maintains contract performance controls, issue logs, validation documentation, and audit-ready support for payer discussions and internal reviews.
• Evaluates reimbursement policy changes and payer implementation of negotiated terms; identifies variances between executed language and operational payment practices.
• Tracks unresolved contract implementation issues, deadlines, financial exposure, and corrective actions, with timely escalation of material risks.

4 Job Function: Managed Care Reporting & Financial Forecasting
• Develops recurring payer scorecards and executive reports on reimbursement yield, net revenue, denials, underpayments, contract compliance, and financial performance.
• Performs trend, variance, benchmark, and root-cause analysis across payer, product, facility, service line, and reimbursement methodology.
• Works with Finance and Revenue Cycle to validate assumptions, reconcile reporting differences, and estimate financial impact of payer performance issues.
• Communicates concise findings and recommendations to support leadership decisions and prioritization.

5 Job Function: Contracting Strategy & Cross-Functional Improvement
• Provides analytical support for payer negotiations, renewals, amendments, and implementation by evaluating contract provisions and projected reimbursement outcomes.
• Collaborates with Contracting, Finance, Revenue Cycle, and operational stakeholders to identify workflow and payer-policy issues affecting reimbursement.
• Supports validation of contract loading and rate implementation and recommends monitoring or corrective actions.

6 Job Function: Other
• Other duties as assigned.

FINANCIAL IMPACT AND RESPONSIBILITIES:
Responsible for analyzing payer reimbursement performance and quantifying contract-related revenue opportunities and financial exposure, including rate changes, underpayments, denials, recoupments, and implementation variances. Develops financial models and recovery estimates to inform payer negotiations, issue escalation, and leadership decisions. No direct budget authority.
EDUCATION : (please list what is required)
Bachelor's Degree
LICENSE & CERTIFICATION:
None
YEARS OF EXPERIENCE:
3 - 5 Years equivalent experience in managed care contracting, reimbursement analysis, healthcare finance, revenue cycle analytics, or payer performance
REQUIRED SKILLS AND KNOWLEDGE :
Knowledge of managed care contracting and commercial and government payer reimbursement methodologies, including DRG, APC, fee schedules, case rates, percent-of-charge, and stop-loss provisions.
• Ability to interpret executed payer contract language, reimbursement appendices, administrative provisions, and payer payment policies.
• Experience analyzing healthcare claims, remittance data, denials, appeals, underpayments, recoupments, and reimbursement variances.
• Strong financial and analytical skills in rate modeling, forecasting, trend analysis, variance analysis, and quantification of net revenue impact.
• Ability to reconcile expected reimbursement to actual payer payments and investigate complex payment methodology discrepancies.
• Knowledge of contract compliance monitoring, payer issue documentation, audit controls, and implementation validation.
• Ability to develop evidence-based payer escalation materials and recommend financially sound issue resolution priorities.
• Excellent written and verbal communication skills to explain complex reimbursement and operational findings to payer representatives and senior leadership.
• Advanced Excel and healthcare reporting experience; SQL, Power BI, Tableau, Epic, contract modeling, or revenue cycle analytics platforms preferred.
• Strong organization and project management skills to manage multiple payer contracts, analytical requests, and deadlines.
• Ability to collaborate across Managed Care, Contracting, Finance, Revenue Cycle, Clinical Operations, and external payers while exercising independent judgment.
• Demonstrated commitment to accuracy, confidentiality, integrity, accountability, and continuous improvement.

WORK ENVIRONMENT
While the position will work in a normal office environment, travel to the various hospitals and work locations will be necessary. Work hours will vary from time to time depending upon the needs of the business. Regular and predictable on-site attendance is required for this position.