Managed Care Contract Analyst

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Job Type

Full-time

Description

Manages the life cycle of payer agreements across commercial and government programs. Responsible for the accurate configuration and maintenance of contracts in the NextGen Contract Utility, supporting both traditional fee-for-service (FFS) reimbursement and managed care models including capitated, global payment, and percent-of-premium arrangements. Supports strategy development, modeling contract scenarios, and ensuring that contract terms are operationalized accurately to support revenue integrity.

Essential Functions

Load, maintain, and update complex payer contracts in the NextGen Contract Utility, including support for multiple fee schedules, modifier logic, payment methodologies, tiered structures, and capitation terms.

Audit contracts to ensure alignment between system configuration and written agreements, including validation of payment terms, effective dates, carve-outs, and inclusions / exclusions.

Test contract builds using simulated claims to confirm accurate payment logic and resolve discrepancies.

Document contract load workflows, fee schedule versions, and update history for internal tracking and audit readiness.

Analyze current contract performance, including reimbursement trends, underpayment rates, capitation-to-cost comparisons, and payer mix shifts.

Model reimbursement scenarios under prospective contracts, including breakeven analysis, rate benchmarking, and volume forecasting.

Provide insights and actionable recommendations to leadership to support negotiation strategy and rate improvement efforts.

Monitor payer contract KPIs such as net revenue realization, gross-to-net adjustments, clean claim rates, and claims lag variance.

Perform adhoc data analyses to assist the Revenue Cycle Director and leadership in the assessment and interpretation of KPI metrics as well as during negotiations.

Assist in preparing redlined agreements, rate grids, and side-by-side contract comparisons for both new contracts and renewals.

Participate in payer meetings and internal planning sessions, translating clinical and operational requirements into payer terms.

Track negotiation timelines, notification deadlines, contract expirations, and renewal cycles.

Coordinate with legal, compliance, billing, and credentialing teams to ensure seamless implementation of negotiated agreements.

Act as the liaison between Managed Care, Revenue Cycle, IT, and Clinical Operations for contract-related system issues or operational impacts.

Partner with billing and collections teams to resolve payment variances and support appeals, recoupments, and retroactive payment disputes.

Provide contract education to operations and front-end staff to ensure proper application of insurance eligibility, copay structure, and referral requirements.

Maintain centralized and well-organized documentation of all executed contracts, amendments, payer correspondence, and fee schedule versions.

Ensure contracts are compliant with regulatory and accreditation requirements (CMS, AHCA, Medicaid rules).

Support internal and external audits by providing contract data, system screenshots, and reconciliation logs.

Stay current on industry trends in managed care contracting and reimbursement methodologies.

Requirements

Job Specification

Typically has the following skills or abilities :

Bachelor's degree in Healthcare Administration, Health Information Management, Business, Finance, Accounting, or related field or equivalent experience.

Master's degree or professional certification (e.g., CHFP, CPC, HFMA) preferred.

4+ years of experience in healthcare contracting, provider reimbursement, revenue cycle, or payer relations.

Expert knowledge of both fee-for-service and managed care reimbursement models, with direct experience managing capitated contracts.

Hands-on experience with NextGen EPM and Contract Utility or similar EHR / PM system (e.g., Athena, eCW, Allscripts) strongly preferred.

Prior experience with ophthalmology, specialty care, or multi-site ambulatory providers is a plus.

Advanced Excel skills (pivot tables, VLOOKUP, complex formulas); experience with Access or Power BI a plus

High attention to detail; able to audit, validate, and troubleshoot complex contract configurations

Strong analytical and critical thinking skills; able to interpret legal / financial terms and apply operational implications

Effective written and verbal communicator; able to distill technical issues into plain language for non-technical audiences

Self-directed, with strong organizational skills and the ability to manage multiple competing priorities

Strong sense of integrity and discretion with sensitive financial data

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VSP Vision is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to age, gender, race, color, religion, sex, national origin, disability, or protected veteran status. We maintain a drug-free workplace and perform pre-employment substance abuse testing.

The compensation range for the role is listed below. Applicable salary ranges may differ across markets. Actual pay will be determined based on experience and other job-related factors permitted by law. As a part of the compensation package, this role may include eligible bonuses and commissions. For more information regarding iCare benefits, please click here .

Salary Description

$75,000 - $86,000