Managed Care Analyst

Job Description

Job Description

Managed Care Analyst - Remote, Houston, TX

Location: Remote - Houston, TX (Local candidates preferred)

Pay Rate: Starting at $41.00/hour

Schedule: Monday-Friday | 8:00 AM-5:00 PM

Dean's Professional Services is seeking an experienced Managed Care Analyst to support a leading healthcare organization. This position focuses on managed care contract modeling, healthcare reimbursement analysis, and revenue cycle optimization using Epic and advanced reporting tools. The ideal candidate has strong technical and analytical skills, a deep understanding of healthcare reimbursement methodologies, and the ability to translate complex contract terms and financial data into actionable business insights.

Responsibilities

Epic Contract Modeling and System Administration

• Build, test, implement, and maintain managed care contracts in Epic Contract Maintenance and Contract Modeling for hospital billing (HB) and professional billing (PB).

   

• Configure complex contract rules, components, and extensions to support accurate expected reimbursement calculations across multiple service lines.

   

• Perform Epic system build and maintenance within Hyperdrive, Text, PJX/SUP, REL, and Data Courier environments.

   

• Participate in Epic upgrades, testing, enhancements, and ongoing system optimization.

   

• Maintain required Epic certifications and continuously develop technical and analytical expertise.

   

Data Analysis and Reporting

• Conduct quantitative and qualitative analyses to support revenue cycle performance, reimbursement accuracy, financial reporting, and managed care contract functions.

   

• Analyze contract performance, payer trends, denials, and regulatory impacts to identify root causes and improvement opportunities.

   

• Develop reports, dashboards, and data visualizations using tools such as Epic Reporting, SAP BusinessObjects (WebI/SAP Universes), StrataJazz, Power BI, and Microsoft Excel.

   

• Create scalable, self-service reporting solutions that help stakeholders make informed, data-driven decisions.

   

• Present analytical findings clearly, accurately, and with actionable recommendations.

   

Managed Care and Reimbursement

• Interpret managed care contracts and payer policies to accurately model payment terms within Epic.

   

• Evaluate reimbursement methodologies, including CPT, HCPCS, MS-DRG, APC, and ICD-10, and assess their financial impact.

   

• Monitor contract performance to identify reimbursement discrepancies, compliance concerns, and opportunities for improvement.

   

• Maintain knowledge of third-party reimbursement requirements, including Medicare, Medicaid, Medicare Advantage, and commercial payers.

   

• Identify revenue opportunities, financial risks, and cost-saving initiatives through contract performance analysis.

   

Collaboration and Process Improvement

• Partner with Managed Care, Patient Access, Financial Services, Information Technology, and Revenue Cycle teams.

   

• Gather business requirements and communicate technical findings to nontechnical audiences and leadership.

   

• Maintain proactive communication with stakeholders throughout projects and deliverables.

   

• Develop and update documentation, workflows, and best-practice guides for Epic contract modeling and reporting.

   

• Participate in cross-functional training and knowledge sharing.

   

• Collaborate with technical and operational teams to improve workflows, streamline processes, and maintain data integrity.

   

Qualifications

• Bachelor's degree required in Business Administration, Healthcare Management, Hospital Administration, Finance, Statistics, Economics, Industrial Engineering, Information Services, or a related field.

   

• Minimum of 5 years of experience in managed care and/or healthcare reimbursement required