Managed Care Performance Analyst, Full Time, First Shift

Under minimal supervision, the Managed Care Performance Analyst evaluates financial, operational, and contractual performance across UC Health commercial and government payer agreements. The analyst interprets reimbursement terms, models contracted rate changes, validates expected versus actual payments, and analyzes underpayments, denials, utilization, and net revenue trends to identify financial exposure and recovery opportunities. This role monitors payer compliance with contract requirements, supports issue escalation and resolution, and develops defensible analyses for negotiations, amendments, and operational improvement. The analyst collaborates with Managed Care, Finance, Revenue Cycle, Contracting, Clinical Operations, and payer representatives to deliver actionable performance reporting and recommendations to leadership.

FINANCIAL IMPACT AND RESPONSIBILITIES:

Responsible for analyzing payer reimbursement performance and quantifying contract-related revenue opportunities and financial exposure, including rate changes, underpayments, denials, recoupments, and implementation variances. Develops financial models and recovery estimates to inform payer negotiations, issue escalation, and leadership decisions. No direct budget authority.

EDUCATION : (please list what is required)

Bachelor's Degree

LICENSE & CERTIFICATION:

None

YEARS OF EXPERIENCE:

3 - 5 Years equivalent experience in managed care contracting, reimbursement analysis, healthcare finance, revenue cycle analytics, or payer performance

REQUIRED SKILLS AND KNOWLEDGE :

Knowledge of managed care contracting and commercial and government payer reimbursement methodologies, including DRG, APC, fee schedules, case rates, percent-of-charge, and stop-loss provisions.

- Ability to interpret executed payer contract language, reimbursement appendices, administrative provisions, and payer payment policies.
- Experience analyzing healthcare claims, remittance data, denials, appeals, underpayments, recoupments, and reimbursement variances.
- Strong financial and analytical skills in rate modeling, forecasting, trend analysis, variance analysis, and quantification of net revenue impact.
- Ability to reconcile expected reimbursement to actual payer payments and investigate complex payment methodology discrepancies.
- Knowledge of contract compliance monitoring, payer issue documentation, audit controls, and implementation validation.
- Ability to develop evidence-based payer escalation materials and recommend financially sound issue resolution priorities.
- Excellent written and verbal communication skills to explain complex reimbursement and operational findings to payer representatives and senior leadership.
- Advanced Excel and healthcare reporting experience; SQL, Power BI, Tableau, Epic, contract modeling, or revenue cycle analytics platforms preferred.
- Strong organization and project management skills to manage multiple payer contracts, analytical requests, and deadlines.
- Ability to collaborate across Managed Care, Contracting, Finance, Revenue Cycle, Clinical Operations, and external payers while exercising independent judgment.
- Demonstrated commitment to accuracy, confidentiality, integrity, accountability, and continuous improvement.

WORK ENVIRONMENT

While the position will work in a normal office environment, travel to the various hospitals and work locations will be necessary. Work hours will vary from time to time depending upon the needs of the business. Regular and predictable on-site attendance is required for this position.