MedStar Health · 1 month ago
Managed Care Analytics Director
Columbia, MD
Full-time
Onsite
Lead/Staff, Director/Executive
$114K/yr - $220K/yr
5+ years expMedStar Health is overseeing analytic functions that support their Managed Care Operations Department. The Managed Care Analytics Director will lead reimbursement and financial analyses essential to contract negotiations and develop strategic insights for financial strategy and performance monitoring.
Health CareMedical
Responsibilities
Oversees analytic functions supporting MedStar Health Managed Care Operations Department which performs reimbursement and financial analyses essential to contract negotiations and system initiatives
Prepares to report in response to business needs and develops and maintains databases
Actively participates in strategic discussions re. physician hospital and diversified company rate negotiations
Evaluates and provide key input into the determination of financial strategy for payer proposals in collaboration with Managed Care leadership to ensure Managed Care goals are supported
Develops reimbursement forecasts and monitors contract performance
Supports analytics for system-wide projects and workgroups
Develops reimbursement models and reports in support of managed care contracting activities by utilizing a variety of platforms and other available reporting tools to produce interactive and efficient data analytics
Frequently interfaces with external payers regarding reimbursement models and analyses in support of contract negotiations
Monitors payer performance and oversees profiling and reporting regarding payer utilization profitability and financial trends including benchmarking payers against Medicare and each other
Oversees external market analyses
Compiles published financial and utilization information re. managed care companies
Profiles competitors or competitive clinical services
Develops a global assessment of the regional health care market to influence internal strategic decisions regarding program development and rate methodologies
Performs ad hoc financial reporting as needed with minimal guidance and remains current on the latest healthcare issues and reimbursement trends
Validates data extracts and analyzes any discrepancies
Develops reimbursement models and reports in support of managed care contracting activities by utilizing a variety of platforms and other available reporting tools to produce interactive and efficient data analytics
Performs other duties as assigned for both Managed Care staff and for MedStar Associates in other departments including Finance Planning and Diversified
Serves as a key member of interdisciplinary teams (physicians finance and administrators) to provide operational and contract support for carve-outs including Understanding the process flow and making recommendations for changes to improve efficiency and maximize reimbursement; develops and updates business rules for distribution to global billing company; conducts reporting on financial outcomes and prepares reports for regulatory agencies as needed
Acts as trouble-shooter interfaces with internal billing groups providers and payers to resolve problems
Serves as primary contact and resource with Finance (including Patient Accounts and Patient Financial Service) regarding contract interpretation coding requirements and other managed care reimbursement issues
Serves as primary contact with billing departments and/or external billing companies to secure analyze and report physician utilization and reimbursement rates
Structures coordinates consolidates and presents financial and statistical information related to Managed Care Operations to ensure complete accurate and timely financial reporting to management
Scope includes hospital physician diversified business and global reporting
Understands functioning data requirements and revenue implications of various hospital and physician payment methodologies including Medicare IPPS OPPS RBRVS systems; and Medicaid fee-for-service and capitation arrangements
Works with internal clients to resolve issues recommends process improvement regarding reimbursement issues and recommends future contract changes to enhance reimbursement and overall contract performance
Qualification
Required
Bachelor's degree in Healthcare Administration, Finance, Business Administration, or related field required
5-7 years Healthcare analytics database management and information management. Managed care payor or multi-hospital health system reimbursement experience required
Knowledge of healthcare delivery settings clinical data management and health care insurance required
Project management strategic and tactical planning and problem-resolution skills
Communications skills for effective executive team interaction
Advanced proficiency with Microsoft product suite (MS Word Excel Power Point Access) and standard project management software (i.e. spreadsheets databases graphics presentation tools etc.)
Detailed knowledge with both Medicare and commercial provider reimbursement methods (DRG RBRVS ASC Per Diem Capitation and Value-Based reimbursement)
A solid understanding of medical coding (ICD CPT) and business terminology
The ability to access data through different systems is required to complete analysis and reporting requirements
Advanced knowledge of Microsoft Office Suite particularly MS Excel and Access
Self-motivated individual capable of managing time and prioritizing work across multiple priorities in a demanding business environment
Ability to work with diverse groups of people to achieve desired results as well as interpersonal skills to interact effectively with management staff and outside entities
Preferred
Master's degree MBA MHS or other graduate degree with a health care or information systems concentration preferred
No special certification registration or licensure required
Company
MedStar Health
MedStar Health is a not-for-profit healthcare organization
10001+ employees
H1B Sponsorship
MedStar Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (18)
2024 (13)
2023 (14)
2022 (14)
2021 (12)
2020 (14)
Funding
Current Stage
Late StageTotal Funding
$29MKey Investors
American Medical AssociationAgency for Healthcare Research and QualityA. James and Alice B. Clark Foundation
2023-06-21Grant
2022-09-27Grant· $2M
2020-07-03Grant· $27M
Leadership Team
David Mayer
Executive Director MedStar Institute for Quality and Safety Quality and Safety CEO Patient Safety Mo
Recent News
2025-12-17
Maryland Daily Record
2025-12-05
Company data provided by crunchbase