Remote Managed Care Analyst

Job Summary:

Senior Consultant Advisor, Oracle Health Jonathan Jenkins is recruiting this position.

email me linkedin

Healthcare IT Leaders is seeking a Full Time REMOTE Managed Care/Reimbursement Analyst for a long term, contracting opportunity. Start date is ASAP.

Must be able to work EST business hours M-F

Responsibilities

• Must have experience across hospital managed care contracts, reimbursement modeling, payer analytics, advanced Excel modeling, claims analysis, and revenue cycle consulting for a remote opportunity.
• Analyze hospital managed care contracts and translate reimbursement terms into financial impact models
• Build, maintain, and improve Excel based models for contract analysis, reimbursement validation, payer performance, and scenario modeling
• Compare expected reimbursement against actual claims and remittance data to identify underpayments, payment variance, denial trends, and payer behavior patterns
• Support zero balance audit recovery, denial reporting, underpayment analysis, and payer contract compliance reviews
• Create client facing reports and summaries that explain reimbursement trends, revenue opportunity, payer performance, and areas of revenue leakage
• Validate data for accuracy and reasonableness, including identifying outliers, incorrect formulas, questionable payment patterns, and contract modeling issues
• Work independently with leadership and client stakeholders to turn claims, contract, and reimbursement data into clear business recommendations

Requirements

• Strong hospital managed care contract experience required
• Strong reimbursement analysis experience required, preferably in a hospital or health system setting
• Advanced Excel skills required, including formulas, pivot tables, lookups, large datasets, multi sheet models, and model troubleshooting
• Experience reading and interpreting commercial payer contract terms, rate exhibits, reimbursement language, fee schedules, carve outs, case rates, per diems, DRG based reimbursement, bundled rates, and related payment methodologies
• Experience calculating expected reimbursement and comparing it against actual claims, remittance data, payer behavior, and contract terms
• Experience identifying underpayments, denial trends, payment variance, payer delays, contract compliance issues, and revenue leakage
• Experience working with claims data, remittance data, hospital billing data, payer reports, revenue cycle data, or similar healthcare finance datasets
• Ability to validate data for accuracy and reasonableness, including identifying outliers, incorrect reimbursement, inaccurate formulas, and questionable payment patterns
• Prior experience in hospital managed care, reimbursement analytics, revenue cycle analytics, decision support, payer contract analysis, healthcare finance, or healthcare consulting strongly preferred
• Ability to work independently, manage analysis from start to finish, and communicate findings clearly to leadership and client stakeholders
• Must have managed care contract, and Excel modeling experience

To learn more about this and other positions, contact Jonathan Jenkins at (603) 475-8168 or jonathan.jenkins@healthcareitleaders.com. Healthcare IT Leaders is a national leader in IT workforce solutions, connecting healthcare provider, payer and life sciences organizations with experienced technology talent for consulting and full-time hiring. For more information, visit us on the web at www.healthcareitleaders.com.