Managed Care Contract Analyst

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $65k - $75k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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Ob Hospitalist Group

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2006

🏥 Healthcare

💊 Pharmaceuticals

Healthcare • Pharmaceuticals

Ob Hospitalist Group (OBHG) is the nation’s largest provider of OB/GYN hospitalists and a leader in tailored women’s health solutions. Through our core hospitalist programs and Maternal Health Access Solutions (MHAS), we bring expert obstetric care to hospitals across the country. We partner with hospitals to strengthen maternal safety, reduce physician burnout, and ensure access to quality care for every community we serve. With nearly 2,000 clinicians working alongside local OB/GYNs, OBHG delivers timely, specialized care for every pregnant woman. Headquartered in Greenville, SC, we are dedicated to advancing maternal health nationwide.

📋 Description

• Support managed care contracting strategies for Obtelecare programs • Conduct payer research and track contracting opportunities • Support contract implementation and agreement maintenance • Review, interpret, and summarize payer agreements, reimbursement terms, billing requirements, credentialing requirements, payer enrollment details, state-specific provisions, and contract notice provisions • Evaluate fee schedules, reimbursement terms, payer behavior, underpayments, trends, and variances • Maintain contract summary sheets, fee schedule crosswalks, payer lists, rosters, contract status reports, workflow metrics, and other contracting documentation • Partner with Revenue Cycle Management, operations, credentialing, payer enrollment, and payer representatives to resolve escalated claims, reimbursement, and contract interpretation issues • Create ad-hoc reports and data analyses related to payment trends, denials, payer performance, reimbursement variances, and contract-related opportunities • Maintain contract-related training materials, reference documents, and process guides • Securely manage contract documentation, payer information, and Protected Health Information in accordance with company policies and regulatory requirements

🎯 Requirements

• Minimum of 5 years of experience in managed care contracting, payer relations, provider relations, revenue cycle, or healthcare contracting • Strong understanding of Revenue Cycle Management, managed care contract language, reimbursement methodologies, payer operations, contract interpretation, and healthcare regulatory considerations • Ability to analyze complex payer agreements, identify reimbursement or process improvement opportunities, research payer issues, and recommend solutions • Excellent analytical, organizational, communication, documentation, and follow-up skills with strong attention to detail • Proficiency with Microsoft Word, Excel, and contract or revenue cycle systems • Bachelor’s degree in business administration, accounting, finance, healthcare, or a related field preferred; equivalent work experience may be considered • Experience with healthcare analytics, contract modeling, reimbursement analysis, reporting tools, ECHO, data warehouse reporting, or advanced Excel is a plus • Ability to handle contract documentation, payer information, and Protected Health Information securely and in alignment with company policies and regulatory requirements

🏖️ Benefits

• Full-time, benefit eligible • Paid time off and holidays • Medical, dental, and vision insurance • Health Savings Account with employer contribution • Flexible Spending Account options • Employer-paid basic life and AD&D insurance • Employer-paid short- and long-term disability • Optional short-term disability buy-up plan • Paid parental leave • 401(k) savings plan with match • Legal plan and identity theft services • Mental health support and resources • Mission-based company culture • Occasional travel may be required for meetings, training, or business needs