Senior Manager, Managed Care Analytics - Full Time - Days - Corporate

The Senior Manager of Managed Care Analytics serves as the enterprise leader for payer analytics, reimbursement modeling, and data governance across the managed care contracting lifecycle. This role is the system’s chief data steward for managed care, responsible for ensuring analytical accuracy, methodological consistency, and strategic insight that directly shapes payer negotiations, revenue integrity, and long‑term financial performance. This leader oversees a team of analysts and collaborates closely with Managed Care, Finance, Revenue Cycle, Population Health, Clinical Operations, and executive leadership. The Director drives the development of advanced financial models, contract repricing engines, payer scorecards, and market intelligence tools that support both fee‑for‑service and value‑based arrangements.

• Serve as the Managed Care department’s data steward, ensuring data accuracy
• Partner with IT, Finance, Revenue Cycle, and Informatics to align data sources, methodologies, and reporting infrastructure.
• Lead financial modeling and repricing analyses to support payer contract negotiations across hospital, physician, ancillary, and value based arrangements.
• Analyze historical and projected payer performance, including medical cost trends, utilization patterns, yield changes, and reimbursement impacts.
• Forecast financial risks and opportunities associated with managed care contracts.
• Serve as the subject matter expert on reimbursement methodologies (DRG, per diem, percent of charge, fee schedule, etc.).
• Oversee the creation of dashboards that track fee for service and value based contract performance
• Build payer/program specific P&Ls and profitability analyses.
• Query, integrate, and normalize complex datasets (hospital, professional billing, pharmacy, claims, third party sources).
• Maintain market intelligence tools, including competitor profiling and regional market assessments.
• Validate data extracts, troubleshoot discrepancies, and ensure analytical accuracy.
• Use Epic tools to model contract changes, forecast reimbursement impacts, and support negotiation strategy.
• Collaborate with the Director of Managed Care to prioritize and assign analytical work, review outputs, and ensure adherence to data governance standards.
• Foster a collaborative, high-performance analytical environment.
• Act as a key analytical partner to Finance, Revenue Cycle, ACO/Population Health, Clinical Operations, and other stakeholders.
• Participate in interdisciplinary workgroups and system wide initiatives requiring payer analytics or reimbursement expertise.
• Clearly convey complex analytical insights to leadership and diverse stakeholder groups
• Serve as the system expert on DRG, APC, fee schedule, percent of charge, bundled payments, and emerging reimbursement methodologies.
• Lead payer proposal evaluation, counter proposal development, and negotiation analytics.
• Develop dashboards and scorecards that track payer performance, yield, denial trends, PMPM, MLR, TME, and value-based metrics.
• Build payer specific P&Ls and profitability analyses.
• Monitor medical cost trends, utilization patterns, and reimbursement shifts
• Drive automation of recurring analytics, including SQL pipelines, BI dashboards, and contract modeling workflows

• Bachelor’s degree in Healthcare Administration, Business, Public Health, Mathematics, Informatics, Computer Science, or related field.
• Master’s degree (MBA, MHA, MPH, Informatics) preferred.

Experience

• 5–8 years of experience in medical cost analytics, managed care analytics, actuarial analysis, or related healthcare data roles preferred
• Experience leading analytical projects or teams; project management experience preferred.
• Strong understanding of managed care reimbursement methodologies and medical economics metrics (PMPM, MLR, TME, etc.).
• Experience working with healthcare claims, encounter data, and financial modeling.
• Proficiency in SQL, Excel (advanced modeling, macros/VBA), and BI tools such as Power BI, Tableau, or Spotfire.

Certifications

• Epic Resolute Hospital Billing and/or Professional Billing Contract Administration preferred; required within 9 months if not already certified.