Managed Care Contract Analyst

The Managed Care Contract Analyst plays a critical role in supporting managed care contracting activities for telehealth and virtual care programs. This position is responsible for analyzing, organizing, and maintaining payer agreements; supporting contract implementation; monitoring reimbursement terms; and facilitating effective communication between Revenue Cycle Management, operations, credentialing, payer enrollment, and payer representatives. The Analyst will leverage analytical, documentation, and problem-solving skills to support contract performance, reimbursement accuracy, compliance, and the organization's financial and operational objectives.

Contract Management

• Support managed care contracting initiatives for telehealth and virtual care programs by researching payers, tracking contracting opportunities, assisting with agreement execution, and maintaining contract records.

Contract Analysis

• Review, interpret, and summarize complex payer agreements by documenting key operational requirements, including reimbursement methodologies, credentialing requirements, enrollment provisions, billing guidelines, state-specific regulations, and contract notice provisions.

Fee Schedule Evaluation

• Assess fee schedules and reimbursement structures across commercial, government, and managed care plans.
• Maintain reimbursement tracking tools and fee schedule documentation.
• Analyze reimbursement trends, variances, underpayments, and payer behavior, and collaborate with payers to support payment accuracy.

Rate Management

• Maintain, validate, and audit contract rate calculations for payer agreements.
• Ensure rates are accurately reflected for new, amended, and renegotiated contracts.
• Provide internal teams with guidance regarding reimbursement methodologies and contract interpretation.

Reporting & Analytics

• Develop and maintain reports related to contracting activity, payer participation, contract status, reimbursement trends, and operational metrics.
• Create analyses to monitor payment trends, denials, reimbursement variances, payer performance, and contract-related issues.
• Provide recommendations to improve reimbursement outcomes and operational efficiency.

Issue Resolution

• Serve as a key resource for payer and revenue cycle issues, researching and resolving escalated claims, reimbursement, and contract interpretation concerns in collaboration with internal stakeholders and payer representatives.

Training & Documentation

• Maintain contract-related reference materials, process documentation, and training resources to support onboarding and operational consistency.

Compliance

• Ensure contract documentation, payer information, and Protected Health Information (PHI) are maintained in accordance with organizational policies and healthcare industry regulations.

• 5+ years of experience in managed care contracting, payer relations, provider relations, revenue cycle management, healthcare reimbursement, or healthcare contract administration.
• Strong understanding of managed care contracting, reimbursement methodologies, payer operations, and revenue cycle processes.
• Experience supporting telehealth, virtual care, physician services, provider groups, healthcare delivery organizations, or related healthcare programs.
• Advanced analytical and problem-solving skills with strong attention to detail.
• Proficiency in Microsoft Excel, Word, and healthcare contract/revenue cycle systems.

• Bachelor's degree in Business, Finance, Healthcare Administration, Accounting, or a related field.
• Knowledge of telehealth reimbursement, provider-based services, multi-state payer contracting, and Medicare/Medicaid reimbursement structures.
• Experience with healthcare analytics, contract modeling, reimbursement analysis, reporting tools, data warehouses, and advanced Excel functions.

Equal Opportunity Employer, including disability and protected veteran status