Managed Care Contract Analyst
REVELOHEALTH, Atlanta, GA, United States
The
Managed Care Contract Analyst
plays a key role in supporting the review, interpretation, and implementation of provider contracts and reimbursement schedules. This position ensures accurate contract configuration, system setup, and validation to support efficient claims processing and provider data integrity.
The ideal candidate brings a solid foundation in healthcare contracting, strong analytical capabilities, and a high level of attention to detail, along with the ability to collaborate effectively across internal teams and external partners.
Responsibilities
Build and/or oversee the development of all provider fee schedule types, including pre-contract modeling and post-execution interpretation.
Manage end-to-end facility and ancillary data entry and maintenance to ensure accurate setup for claims payment, member assignment, and directory display.
Audit provider configurations to ensure contract terms and demographic data are accurately loaded.
Ensure accurate contract loading and validation of all provider agreements.
Support the development and standardization of contract and fee schedule processes.
Partner closely with pricing software vendors to support timely project delivery.
Investigate and resolve provider contract and configuration issues.
Identify trends and recommend process improvements to enhance operational efficiency and mitigate risk.
Monitor and report on provider data quality to ensure benchmarks are met.
Develop and maintain job aids; support training coordination as needed.
Perform additional duties as assigned.
Education and Qualification Requirements
Bachelor’s degree preferred in Finance, Healthcare, Economics, Business, or a related field; equivalent experience (5+ years in provider/healthcare contract management) will be considered.
1–3+ years of experience in code set management and provider reimbursement methodologies.
Experience working with pricing and claims systems (e.g., Trizetto, Facets, Network Pricer).
Strong communication and customer service skills.
Proven ability to build and maintain effective working relationships.
Adaptable and responsive in a fast-paced, evolving environment.
Process-oriented with a focus on continuous improvement.
Highly organized with the ability to manage multiple priorities and deadlines.
Self-starter with strong accountability and follow-through.
Proficient in Microsoft Office tools and SQL-based analytics.
Commitment to maintaining confidentiality and compliance with HIPAA regulations.
Ability to comply with all company policies and pass pre-employment requirements.
Minimal travel required (training or client meetings).
Detail-oriented, goal-driven professional with a proactive mindset.
Strong time management and task execution skills.
Effective communicator who thrives in a collaborative, team-based environment.
Experience in similar roles with hands-on use of tools such as Excel and Access.
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Managed Care Contract Analyst
plays a key role in supporting the review, interpretation, and implementation of provider contracts and reimbursement schedules. This position ensures accurate contract configuration, system setup, and validation to support efficient claims processing and provider data integrity.
The ideal candidate brings a solid foundation in healthcare contracting, strong analytical capabilities, and a high level of attention to detail, along with the ability to collaborate effectively across internal teams and external partners.
Responsibilities
Build and/or oversee the development of all provider fee schedule types, including pre-contract modeling and post-execution interpretation.
Manage end-to-end facility and ancillary data entry and maintenance to ensure accurate setup for claims payment, member assignment, and directory display.
Audit provider configurations to ensure contract terms and demographic data are accurately loaded.
Ensure accurate contract loading and validation of all provider agreements.
Support the development and standardization of contract and fee schedule processes.
Partner closely with pricing software vendors to support timely project delivery.
Investigate and resolve provider contract and configuration issues.
Identify trends and recommend process improvements to enhance operational efficiency and mitigate risk.
Monitor and report on provider data quality to ensure benchmarks are met.
Develop and maintain job aids; support training coordination as needed.
Perform additional duties as assigned.
Education and Qualification Requirements
Bachelor’s degree preferred in Finance, Healthcare, Economics, Business, or a related field; equivalent experience (5+ years in provider/healthcare contract management) will be considered.
1–3+ years of experience in code set management and provider reimbursement methodologies.
Experience working with pricing and claims systems (e.g., Trizetto, Facets, Network Pricer).
Strong communication and customer service skills.
Proven ability to build and maintain effective working relationships.
Adaptable and responsive in a fast-paced, evolving environment.
Process-oriented with a focus on continuous improvement.
Highly organized with the ability to manage multiple priorities and deadlines.
Self-starter with strong accountability and follow-through.
Proficient in Microsoft Office tools and SQL-based analytics.
Commitment to maintaining confidentiality and compliance with HIPAA regulations.
Ability to comply with all company policies and pass pre-employment requirements.
Minimal travel required (training or client meetings).
Detail-oriented, goal-driven professional with a proactive mindset.
Strong time management and task execution skills.
Effective communicator who thrives in a collaborative, team-based environment.
Experience in similar roles with hands-on use of tools such as Excel and Access.
#J-18808-Ljbffr