Note: The job is a remote job and is open to candidates in USA. UT MD Anderson is a leading institution focused on cancer care, research, education, and prevention. The Managed Care Analyst position is responsible for building, maintaining, optimizing, and analyzing managed care contracts to ensure accurate reimbursement calculations and provide analytical insight for operational and clinical decisions.
Responsibilities
- 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
- 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
- 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
- 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
Skills
- Bachelor's Degree Business Administration, Healthcare Management, Hospital Administration, Finance, Statistics, Economics, Industrial Engineering, Information Services or other related fields
- 5 years Experience with managed care contracts and/or managed care contract maintenance and reimbursement
- EPIC - EPIC Certification Epic Resolute Hospital Billing (HB) Expected Reimbursement Contracts Administration Certification within 180 Days
- EPIC - EPIC Certification Epic Resolute Professional Billing (PB) Expected Reimbursement Contracts Administration Certification within 180 Days
- Master's Degree Business Administration, Healthcare Management, Hospital Administration, Finance, Statistics, Economics, Industrial Engineering, Information Services or other related fields
- 5 years Experience with managed care contracts and/or managed care contract maintenance and reimbursement, to include payer relations, contract negotiations, or healthcare decision support systems
- CPC - Certified Professional Coder Upon Hire
- COC - Certified Outpatient Coding Upon Hire
- CCS-Certified Coding Specialist Upon Hire
- Contract Management, Revenue Integrity or Healthcare Finance certification Upon Hire
Benefits
- Employer-paid medical coverage starting day one for employees working 30+ hours/week, plus optional group dental, vision, life, AD&D, and disability insurance.
- Accruals for PTO and Extended Illness Bank, plus paid holidays, wellness, childcare, and other leave options.
- Tuition Assistance Program after six months of service and access to extensive wellness, fitness, and employee resource groups.
- Defined-benefit pension through the Teachers Retirement System, voluntary retirement plans, and employer-paid life and reduced salary protection programs.
- Relocation Assistance Available?
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