Managed Care & Payer Contract Analyst

Description

Manages the life cycle of payer agreements across commercial and government programs. Responsible for the accurate configuration and maintenance of contracts in the NextGen Contract Utility, supporting both traditional fee-for-service (FFS) reimbursement and managed care models, including capitated, global payment, and percent-of-premium arrangements. Supports strategy development, modeling contract scenarios, and ensuring that contract terms are operationalized accurately to support revenue integrity. 

Essential Functions

Load, maintain, and update complex payer contracts in the NextGen Contract Utility, including support for multiple fee schedules, modifier logic, payment methodologies, tiered structures, and capitation terms

Audit contracts to ensure alignment between system configuration and written agreements, including validation of payment terms, effective dates, carve-outs, and inclusions/exclusions

Test contract builds using simulated claims to confirm accurate payment logic and resolve discrepancies

Document contract load workflows, fee schedule versions, and update history for internal tracking and audit readiness

Analyze current contract performance, including reimbursement trends, underpayment rates, capitation-to-cost comparisons, and payer mix shifts

Model reimbursement scenarios under prospective contracts, including breakeven analysis, rate benchmarking, and volume forecasting

Provide insights and actionable recommendations to leadership to support negotiation strategy and rate improvement efforts

Monitor payer contract KPIs such as net revenue realization, gross-to-net adjustments, clean claim rates, and claims lag variance

Perform ad hoc data analyses to assist the Revenue Cycle Director and leadership in the assessment and interpretation of KPI metrics as well as during negotiations

Assist in preparing redlined agreements, rate grids, and side-by-side contract comparisons for both new contracts and renewals

Participate in payer meetings and internal planning sessions, translating clinical and operational requirements into payer terms

Track negotiation timelines, notification deadlines, contract expirations, and renewal cycles

Coordinate with legal, compliance, billing, and credentialing teams to ensure seamless implementation of negotiated agreements

Act as the liaison between Managed Care, Revenue Cycle, IT, and Clinical Operations for contract-related system issues or operational impacts

Partner with billing and collections teams to resolve payment variances and support appeals, recoupments, and retroactive payment disputes

Provide contract education to operations and front-end staff to ensure proper application of insurance eligibility, copay structure, and referral requirements

Maintain centralized and well-organized documentation of all executed contracts, amendments, payer correspondence, and fee schedule versions

Ensure contracts are compliant with regulatory and accreditation requirements (CMS, AHCA, Medicaid rules)

Support internal and external audits by providing contract data, system screenshots, and reconciliation logs

Stay current on industry trends in managed care contracting and reimbursement methodologies

Requirements

Job Specifications 

Typically has the following skills or abilities: 

Bachelor’s degree in Healthcare Administration, Health Information Management, 

Business, Finance, Accounting, or related field, or equivalent experience

4+ years of experience in healthcare contracting, provider reimbursement, revenue cycle, or payer relations

Expert knowledge of both fee-for-service and managed care reimbursement models, with direct experience managing capitated contracts

Hands-on experience with NextGen EPM and Contract Utility, or similar EHR/PM system (e.g., Athena, eCW, Allscripts) strongly preferred

Prior experience with ophthalmology, specialty care, or multi-site ambulatory providers is a plus

Advanced Excel skills (pivot tables, VLOOKUP, complex formulas); experience with Access or Power BI is a plus

High attention to detail; able to audit, validate, and troubleshoot complex contract configurations

Strong analytical and critical thinking skills; able to interpret legal/financial terms and apply operational implications

Effective written and verbal communicator; able to distill technical issues into plain language for non-technical audiences

Self-directed, with strong organizational skills and the ability to manage multiple competing priorities

Strong sense of integrity and discretion with sensitive financial data

Preferred Skills

Master’s degree or professional certification (e.g., CHFP, CPC, HFMA)  

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The compensation range for the role is listed below. Applicable salary ranges may differ across markets. Actual pay will be determined based on experience and other job-related factors permitted by law. As a part of the compensation package, this role may include eligible bonuses and commissions. For more information regarding iCare benefits, please click here.