Managed Care Contract Analyst

Job Title & Specialty Area: Managed Care Contract Analyst

Department: Managed Care

Location: Texas residency required

Shift: Full time

Job Type: Remote

Why Children's Health?

At Children's Health, our mission is to Make Life Better for Children, and we recognize that their health plays a crucial role in achieving this goal.

Through our cutting-edge treatments and affiliation with UT Southwestern, we strive to deliver an extraordinary patient and family experience, ensuring that every moment, big or small, contributes to their overall well-being.

Our dedication to promoting children's health extends beyond our organization and encompasses the broader community. Together, we can make a significant difference in the lives of children and contribute to a brighter and healthier future for all.

Summary:

Primary responsibilities include supporting the administration, configuration, testing, validation, implementation, and maintenance of managed care reimbursement contracts within Epic Professional Billing (PB). The position supports assigned components of the Epic PB/HB contract lifecycle, including contract interpretation, build preparation, testing, reconciliation, maintenance, payer and plan mapping, and issue resolution. Complex interpretation and configuration decisions are escalated to Senior Analysts and/or the Director. Analytics, reporting, and financial modeling are secondary responsibilities used to support Epic configuration, reimbursement validation, contract performance monitoring, and identification of underpayments and revenue opportunities. Responsibilities include data analysis, financial interpretation of contract terms, contract modeling, financial analysis, data validation, developing reimbursement methodologies, maintaining contracts reimbursement in EPIC and identification of revenue enhancing opportunities. Develop alternative financial proposals that are within the budget parameters, based on analysis and modeling of contract performance by developing and preparing revised models using sound rationale, and present recommendations to Managed Care leadership. Support the organization by providing ad-hoc detailed data reports related to Managed Care agreements and Patient Financial Services activity to internal and external customers.

Responsibilities:

• Support Senior Analysts with Epic PB/HB reimbursement contract configuration, testing, validation, implementation, maintenance, and issue resolution.
• Review payer agreements, amendments, fee schedules, payment policies, and communications to identify potential Epic PB requirements; validate interpretation with Senior Analysts.
• Prepare contract build specifications, supporting schedules, test scenarios, implementation records, and audit-ready documentation using established templates.
• Configure and maintain assigned Epic PB/HB contracts, fee schedules, payment logic, payer rules, and related tables within approved scope.
• Perform claim-level testing and reconciliation to confirm Epic expected reimbursement aligns with approved contract terms.

How You'll Be Successful:

WORK EXPERIENCE

• At least 3 years experience in financial analysis, data mining, advanced Excel and reporting required
• At least 3 years experience with hospital/provider billing system, EPIC preferred
• At least 3 years experience in healthcare, contract modeling for facility and professional agreements preferred

EDUCATION

• Bachelors Degree required

LICENSES AND CERTIFICATIONS

• EPIC Certified-2R-EPIC Essential EPIC Resolute Professional Billing Expected Reimbursement Contracts - Time Frame: 1 Year; EPIC Resolute Hospital Billing Expected Reimbursement Contracts - Time Frame: 1 Year

A Place Where You Belong

We put our people first. We welcome, value, and respect the beliefs, identities and experiences of our patients and colleagues. We are committed to delivering culturally effective care, creating meaningful partnerships in the communities we serve, and equipping and developing our team members to make Children's Health a place where everyone can contribute.

Holistic Benefits - How We'll Care for You:

• Employee portion of medical plan premiums are covered after 3 years.
• 4%-10% employee savings plan match based on tenure
• Paid Parental Leave (up to 12 weeks)
• Caregiver Leave
• Adoption and surrogacy reimbursement

As an equal opportunity employer, Children's Health does not discriminate against employees or applicants because of race, color, religion, sex, gender identity and expression, sexual orientation, age, national origin, veteran or military status, disability, or genetic information or any other Federal or State legally-protected status or class. This applies to all aspects of the employer-employee relationship including but not limited to recruitment, hiring, promotion, transfer pay, training, discipline, workforce adjustments, termination, employee benefits, and any other employment-related activity.