Managed Care Analyst

• Position: Managed Care Analyst
• Duration: 9+ months Contract
• Work Location: Houston TX USA 77030 (Remote)

Additional Notes:

• Work Arrangement: Remote position; local candidates preferred.
• Schedule: Monday–Friday, 8:00 a.m.–5:00 p.m.
• Experience: Minimum of five years of experience in managed care and/or healthcare reimbursement. Epic experience is required, along with experience using SAP BusinessObjects (WebI/SAP Universes) or a comparable reporting and data analytics tool.
• Epic Certification: Candidates must hold either an Epic Resolute HB Expected Reimbursement Contracts Administration certification or an Epic Resolute PB Expected Reimbursement Contracts Administration certification upon hire. Both certifications must be obtained within 180 days of hire. Candidates with experience in either hospital billing (HB) or professional billing (PB) will be considered.

Description:

Summary:

The Managed Care Analyst position is responsible for building, maintaining, optimizing, and analyzing managed care contracts within Epic’s Contract Maintenance and Contract Modeling modules for both hospital (HB) and professional (PB) billing environments to ensure accurate reimbursement calculations. This position requires technical expertise in Epic, deep understanding of healthcare financial workflows, and strong analytical skills to ensure contract integrity, accurate reimbursement modeling, and strategic decision support. The Analyst serves as a bridge between technical teams, finance, managed care administrators, and operational teams to translate complex contractual and technical information into actionable business insights, with a focus on advanced data analysis and accurate calculation automation.

Key Functions:

• Epic Contract Management (30%)
• Build, test, implement, and maintain complex contracts within Epic Contract Maintenance to support accurate expected reimbursement calculations across all payer systems.
• Develop and configure advanced HB and PB contract rules, components, and extensions to ensure precise payment modeling across multiple service lines.
• Perform Epic system build and maintenance within Hyperdrive, Text, PJX/SUP, REL, and Data Courier environments.
• Participate in Epic system upgrades, testing, and enhancement activities to maintain system performance and functionality.
• Maintain Epic certification(s) and actively pursue continuous improvement of technical and analytical proficiency.
• Proficient in data analytic tools including, Epic Reporting, SAP BI, Microsoft Excel, including complex formulas, tools, and design.

• Analysis & Data Management (35%)
• Produce high-quality, accurate qualitative and quantitative analyses to support revenue cycle, financial performance, reimbursement, and managed care contract functions.
• Conduct in-depth analyses of contract performance, payer trends, denials, and regulatory impacts to identify root causes and improvement opportunities.
• Ensure all analytical deliverables provide meaningful interpretation, clear presentation, and actionable insights.
• Design and develop innovative reports, dashboards, and data visualizations using tools such as Epic, Business Objects (Webi/SAP Universes), StrataJazz, Power BI, and Excel.
• Develop scalable, self-service reporting solutions that empower stakeholders to make data-driven decisions.

• Epic Contract Modeling (25%)
• Interpret managed care contract and policy language to accurately model and operationalize payment terms within Epic.
• Evaluate payer reimbursement methodologies (CPT, HCPCS, MSDRG, APC, ICD-10, etc.) and assess related financial impacts.
• Monitor and analyze managed care contract performance for compliance, accuracy, and reimbursement optimization.
• Maintain up-to-date knowledge of third-party reimbursement regulations, including Medicare, Medicaid, Medicare Advantage, and commercial payers.
• Identify and communicate revenue opportunities, risk areas, and cost-saving initiatives based on contract performance analyses.

• Customer Service & Collaboration (10%)
• Engage with internal customers through regular meetings, clear documentation of requirements, and timely delivery of results.
• Communicate technical and analytical findings in a clear, concise manner tailored to non-technical audiences and leadership.
• Collaborate effectively with Patient Access, Financial Services, Managed Care, Information Technology, and Revenue Cycle teams to support organizational goals.
• Maintain open, proactive, and professional communication channels with all stakeholders before, during, and after project deliverables.
• Actively participate in cross-functional training and knowledge sharing to enhance team expertise in Epic contract modeling and reporting tools.
• Develop, maintain, and continuously improve internal documentation, workflows, and best practice guides for Epic contract and reporting functions.
• Collaborate with IT, Revenue Cycle, and operational teams to optimize Epic contract workflows, streamline processes, and ensure data integrity.

EDUCATION

Required:

Bachelor's degree in Business Administration, Healthcare Management, Hospital Administration, Finance, Statistics, Economics, Industrial Engineering, Information Services or other related fields.

Preferred:

• Master's degree in Business Administration, Healthcare Management, Hospital Administration, Finance, Statistics, Economics, Industrial Engineering, Information Services or other related fields.
• Advanced coursework or certification in Healthcare Analytics, Data Science, or Revenue Cycle Management is desirable.

• LICENSE/CERTIFICATION
• Required:

• Epic Resolute Hospital Billing (HB) Expected Reimbursement Contracts Administration Certification or Epic Resolute Professional Billing (PB) Expected Reimbursement Contracts Administration Certification upon hire.
• Both Epic Resolute Hospital Billing (HB) and Professional Billing (PB) Expected Reimbursement Contracts Administration Certifications must be obtained within 180 days of hire.

Preferred:

• Both Epic Resolute Hospital Billing (HB) and Professional Billing (PB) Expected Reimbursement Contracts Administration Certifications upon hire.
• Additional certification in Coding (CPC, COC, CCS) or an equivalent Contract Management, Revenue Integrity, or Healthcare Finance certification (e.g., HFMA CHFP, CRCR).

EXPERIENCE

• Required:
• Minimum of five (5) years of experience in managed care and/or healthcare reimbursement.
• Experience with Epic.
• Experience using SAP BusinessObjects (WebI/SAP Universes) or a comparable reporting and data analytics tool.

Preferred

• Prior exposure to payer relations, contract negotiations, or healthcare decision support systems.
• Experience using Epic Reporting and databases, SlicerDicer, StrataJazz, Power BI, or similar reporting tools.