iCareManager

Analyst

• 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.
• 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.

Managed Care Contract Analyst