The Managed Care Analyst position is responsible for building, maintaining, optimizing, and analyzing managed care contracts within Epic's Contract Maintenance and Contract Modeling modules for both hospital (HB) and professional (PB) billing environments to ensure accurate reimbursement calculations. This position requires technical expertise in Epic, deep understanding of healthcare financial workflows, and strong analytical skills to ensure contract integrity, accurate reimbursement modeling, and strategic decision support. The Analyst serves as a bridge between technical teams, finance, managed care administrators, and operational teams to translate complex contractual and technical information into actionable business insights, with a focus on advanced data analysis and accurate calculation automation.
The Managed Care Contract Analyst is an essential part of MD Anderson Cancer Center. MD Anderson Cancer Center is a leading institution focused on cancer care, research, education, and prevention. This role helps ensure data-driven decisions that support clinical, operational, and strategic initiatives across the institution.
The ideal candidate will have experience building, maintaining, and managing managed care contracts in Epic, including hands-on experience with Epic contract modeling.
The typical work schedule is Monday - Friday 8am - 5pm.
Work Location: Remote (Must be able to attend meetings onsite).
Responsibilities
Epic Contract Management (30%)
o Build, test, implement, and maintain complex contracts within Epic Contract Maintenance to support accurate expected reimbursement calculations across all payer systems.
o Develop and configure advanced HB and PB contract rules, components, and extensions to ensure precise payment modeling across multiple service lines.
o Perform Epic system build and maintenance within Hyperdrive, Text, PJX/SUP, REL, and Data Courier environments.
o Participate in Epic system upgrades, testing, and enhancement activities to maintain system performance and functionality.
o Maintain Epic certification(s) and actively pursue continuous improvement of technical and analytical proficiency.
o Proficient in data analytic tools including, Epic Reporting, SAP BI, Microsoft Excel, including complex formulas, tools, and design.
Analysis & Data Management (35%)
o Produce high-quality, accurate qualitative and quantitative analyses to support revenue cycle, financial performance, reimbursement, and managed care contract functions.
o Conduct in-depth analyses of contract performance, payer trends, denials, and regulatory impacts to identify root causes and improvement opportunities.
o Ensure all analytical deliverables provide meaningful interpretation, clear presentation, and actionable insights.
o Design and develop innovative reports, dashboards, and data visualizations using tools such as Epic, Business Objects (Webi/SAP Universes), StrataJazz, Power BI, and Excel.
o Develop scalable, self-service reporting solutions that empower stakeholders to make data-driven decisions.
Epic Contract Modeling (25%)
o Interpret managed care contract and policy language to accurately model and operationalize payment terms within Epic.
o Evaluate payer reimbursement methodologies (CPT, HCPCS, MSDRG, APC, ICD-10, etc.) and assess related financial impacts.
o Monitor and analyze managed care contract performance for compliance, accuracy, and reimbursement optimization.
o Maintain up-to-date knowledge of third-party reimbursement regulations, including Medicare, Medicaid, Medicare Advantage, and commercial payers.
o Identify and communicate revenue opportunities, risk areas, and cost-saving initiatives based on contract performance analyses.
Customer Service & Collaboration (10%)
o Engage with internal customers through regular meetings, clear documentation of requirements, and timely delivery of results.
o Communicate technical and analytical findings in a clear, concise manner tailored to non-technical audiences and leadership.
o Collaborate effectively with Patient Access, Financial Services, Managed Care, Information Technology, and Revenue Cycle teams to support organizational goals.
o Maintain open, proactive, and professional communication channels with all stakeholders before, during, and after project deliverables.
o Actively participate in cross-functional training and knowledge sharing to enhance team expertise in Epic contract modeling and reporting tools.
o Develop, maintain, and continuously improve internal documentation, workflows, and best practice guides for Epic contract and reporting functions.
o Collaborate with IT, Revenue Cycle, and operational teams to optimize Epic contract workflows, streamline processes, and ensure data integrity.
EDUCATION- Required: Bachelor's Degree Business Administration, Healthcare Management, Hospital Administration, Finance, Statistics, Economics, Industrial Engineering, Information Services or other related fields.
- Preferred: Master's Degree Business Administration, Healthcare Management, Hospital Administration, Finance, Statistics, Economics, Industrial Engineering, Information Services or other related fields.
WORK EXPERIENCE- Required: 5 years Experience with managed care contracts and/or managed care contract maintenance and reimbursement.
- Preferred: 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.
LICENSES AND CERTIFICATIONS- Required: EPIC - EPIC Certification Epic Resolute Hospital Billing (HB) Expected Reimbursement Contracts Administration Certification within 180 Days and
- Required: EPIC - EPIC Certification Epic Resolute Professional Billing (PB) Expected Reimbursement Contracts Administration Certification within 180 Days
- Preferred: CPC - Certified Professional Coder Upon Hire
- Preferred: COC - Certified Outpatient Coding Upon Hire
- Preferred: CCS-Certified Coding Specialist Upon Hire
- Preferred: Contract Management, Revenue Integrity or Healthcare Finance certification Upon Hire
The University of Texas MD Anderson Cancer Center offers excellent benefits, including medical, dental, paid time off, retirement, tuition benefits, educational opportunities, and individual and team recognition.
This position may be responsible for maintaining the security and integrity of critical infrastructure, as defined in Section 113.001(2) of the Texas Business and Commerce Code and therefore may require routine reviews and screening. The ability to satisfy and maintain all requirements necessary to ensure the continued security and integrity of such infrastructure is a condition of hire and continued employment.
