Senior Analyst - Managed Care Contracting

Description

Responsibilities

• Review ,analyze, and load managed care payer contracts into Practice Management(PM) systems.
• Accurately enter CPT codes, fee schedules, reimbursement rates, and contract terms for contract loading and maintenance.
• Perform  contract reviews and validation to ensure rate accuracy and compliance with payer agreements.
• Creating chargemaster analysis reports and other payer related reports based on the Ad hoc Requests.
• Maintain and update Medicare, Medicaid, and commercial payer fee schedules and reimbursement methodologies.
• Research and resolve contract discrepancies, reimbursement variances, and payment issues.
• Maintain knowledge of payer names, plans, reimbursement models.

Requirements

Qualifications

• Bachelors degree preferred in Healthcare Administration, Business, Finance, or a related field.
• Minimum  2 years of experience in Managed Care Contracting, Contract Loading,Revenue Cycle Management (RCM), or Healthcare Reimbursement.
• Strong knowledge of Medicare, Medicaid, and commercial payer reimbursement methodologies.
• Hands-on experience reviewing and loading payer contracts into PM systems.
• Good understanding of CPT, HCPCS, coding structures, fee schedules, and provider reimbursement models.
• Familiarity with major payers, health plans, and payer-specific contract terms.
• Strong analytical and problem-solving skills with excellent attention to detail.
• Ability to manage multiple contracts, priorities, and deadlines simultaneously.
• Excellent verbal and written communication skills.

Required Technical Skills

• Advanced Microsoft Excel skills, including: 
  • VLOOKUP
  • XLOOKUP
  • IF(Conditions)
  • Pivot Tables
  • Conditional Formatting
  • Lookup and Data Validation Functions
• Proficiency in Microsoft Office Suite and healthcare contract management systems.

Preferred Skills

• Strong Revenue Cycle Management (RCM) knowledge.
• Experience with contract negotiations and payer discussions is a strong advantage.
• Knowledge of Medicare and Medicaid fee schedules, commercial payer contracts, and reimbursement methodologies.
• Experience working with payer contract loading, variance analysis, and reimbursement reporting.

Candidates with strong contract loading experience, advanced Excel skills, comprehensive knowledge of Medicare, Medicaid, commercial payers, CPT codes, and RCM processes will be highly preferred. Contract negotiation will be considered an added advantage.