Manager, Payer Analytics & Contract Strategy, Full Time

Job Summary

The Manager, Payer Analytics & Contract Strategy is responsible for the strategic oversight, analysis, modeling, monitoring, and optimization of all payer reimbursement agreements across Summit Healthcare. This role serves as the organization's subject matter expert for contract performance, payment variance analysis, reimbursement modeling, and payer strategy.

The Manager leverages the contract manager & modeler platform, electronic medical record (EMR) data, claims data, reimbursement information, and financial analytics to identify underpayments, contractual variances, revenue leakage, reimbursement opportunities, and emerging payer trends. The position partners closely with Revenue Cycle, Finance, Patient Financial Services, Revenue Integrity, Decision Support, Contracting, and Executive Leadership to support payer negotiations, evaluate new service line reimbursement opportunities, and develop data-driven contracting strategies.

This position functions as both an operational leader and strategic advisor, helping ensure that payer contracts align with organizational goals, reimbursement accurately reflects contractual obligations, and leadership has actionable information to guide contracting decisions.

Essential Functions

Payer Contract Management

• Maintain centralized payer contract inventory and governance processes.
• Oversee contract loading, validation, testing, and maintenance within the Contract Manager platform.
• Ensure contractual reimbursement methodologies are accurately configured and validated.
• Coordinate with Legal, Finance, Revenue Cycle, and Contracting on contract implementation and interpretation.
• Maintain documentation of contract terms, reimbursement methodologies, amendments, and negotiation history.

Payment Variance Analysis

• Monitor actual payments against expected reimbursement.
• Identify contract compliance issues, underpayments, and systematic payment variances.
• Lead investigations into payer reimbursement discrepancies.
• Coordinate recovery efforts with payer representatives and internal stakeholders.
• Establish variance thresholds and escalation protocols.

Reimbursement Modeling

• Utilize the Contract Modeler Solution to model:

o New Payer Contracts

o Proposed Reimbursement Changes

o Alternative payment methodologies

o Value-based arrangements

o Bundled payment opportunities

o New service lines and provider recruitment initiatives

• Quantify financial impact of proposed payer contract changes
• Support strategic planning and budgeting through reimbursement forecasting

Payer Strategy and Negotiations

• Participate in the development of payer scorecards and contract performance dashboards.
• Identify contracts requiring renegotiation based on performance, market conditions, or reimbursement trends.
• Provide analytical support during payer negotiations.
• Prepare executive negotiation briefs and financial impact analyses.
• Benchmark payer contracts against current reimbursement performance and organizational goals.

Revenue Optimization

• Identify opportunities for reimbursement improvement and revenue capture.
• Monitor shifts in payer policy, reimbursement methodologies, and regulatory changes.
• Partner with Revenue Integrity to identify recurring revenue leakage patterns.
• Support payment accuracy initiatives across both hospital and professional services.

Data Analytics and Reporting

• Develop executive reporting for:

o Contract performance

o Payment variance trends

o Underpayment recoveries

o Payer profitability

o Reimbursement forecasting

o Negotiation priorities

• Present findings and recommendations to executive leadership.
• Provide reimbursement guidance for strategic growth initiatives and program development.

Other Duties

• Participates in departmental and association wide informational meetings and inservices, including staff meetings, association wide forums, and seminars.
• Reviews department and association wide policies and procedures annually. Develops and maintains new policies and procedures as needed.

Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.

Abilities, Knowledge, and Skills

• Must be able to read, write, understand, and speak English.
• The ideal candidate will combine reimbursement expertise, managed care contract knowledge, advanced healthcare analytics, and revenue cycle operational experience to translate complex contractual payment methodologies into actionable financial and strategic recommendations.
• Medicare reimbursement methodologies
• Medicaid/AHCCCS reimbursement methodologies.
• Commercial payer reimbursement arrangements
• Knowledge and experience in multiple different payment models to include physician fee schedules, DRGs, APR DRGs, case rates, etc
• Contract language interpretation
• Financial Modeling
• Contract Modeling
• Variance Analysis
• Trend Identification
• Forecasting
• Executive Dashboard use
• Advanced Excel
• Experience with reporting platforms to include PowerBI, Tableau, etc
• Business Intelligence platforms
• Claims and remittance review/analytics

Supervisory Responsibilities

• None

Physical Demands

Exerts up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Involves sitting most of the time, but may involve walking or standing for brief periods of time. The worker is subject to substantial overtime, evening meetings, on-call status, contact with chemicals, contact with infectious fluids, heavy lifting, constant standing, extensive close work, extensive computer work, and encounters with upset/disturbed individuals.

Required Education and Experience

Education:

• Bachelor's Degree in Healthcare Administration, Business Administration, Finance, Accounting, Health Information Management, Data Analytics, or related field; and
• Five (5) years of progressively responsible experience in healthcare reimbursement, managed care contracting, payer analytics, revenue cycle, finance, or revenue integrity

OR

• Ten (10) years of progressive healthcare experience in payer contracting, payer analytics, coding and billing processes, reimbursement, revenue cycle functions, finance, revenue integrity, or related healthcare operational disciplines in lieu of a bachelor's degree.

Experience:

• 5+ years healthcare reimbursement, managed care, payer analytics, finance, or revenue cycle experience.
• 3+ years progressive leadership experience.
• Experience implementing new initiatives, technologies, or programs
• Experience interpreting complex payer contracts.
• Experience with hospital and professional reimbursement methodologies.
• Demonstrated ability to lead cross-functional initiatives, influence stakeholders, and present complex financial information to executive leadership.

Preferred Education and Experience

• FinThrive platforms
• Altera systems
• Experience in medical coding, billing, reimbursement methodologies
• Revenue Cycle Analytics and related platforms
• Managed Care Contracting
• Rural hospital or Critical Access Hospital experience

OSHA Exposure Category:

Involves no regular exposure to blood, body fluids, or tissues, and tasks that involve exposure to blood, body fluids, or tissues and are not a condition of employment.

This is a safety sensitive position.