Provides financial analysis and contract modeling support for managed care contracting leaders. Retrieves reimbursement data, evaluates payer methodology proposals, interprets contracts, validates financial models, performs monthly data-load quality assurance, and prepares analytical reports. The role requires expertise in hospital and physician reimbursement methodologies, billing and coding terminology, healthcare product lines, Excel, and contract modeling systems.
Job Summary
Provides data retrieval / contract modeling / financial analysis support to Director, VP, and Managed Care Regional Contracting Directors.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
- Retrieves reimbursement data from hospital and physician accounting systems.
- Builds financial models to analyze and evaluate the reimbursement impact of hospital and physician payer reimbursement methodology proposals
- Works with Managed Care Regional Contracting Directors on contract interpretation issues to ensure accuracy of contract models and financial analysis.
- Produces clear and concise written reports summarizing payment modeling analysis.
- QA monthly data loads.
- Completes special projects/reports as needed
Qualifications:
- Well versed in reimbursement methodology including DRG, APC, COPPS, OPPS, Case Rates, Per Diems, HCPCS and CPT Code Fee Schedules (2-5 years’ experience).
- Familiar with hospital and physician billing and coding terminology including diagnostic codes, revenue codes, procedure codes, and HCPCS codes.
- Well versed in healthcare product lines including HMO, PPO, HIX, Medicare, Medicaid, Tricare, Workers Comp.
- Must be able to clearly communicate complex and technical issues in writing and verbally.
- Must have the ability to work independently and manage multiple projects simultaneously
Computer Skills:
To perform this job successfully, an individual should have knowledge of
- Word Processing software
- Exceptional skills in Excel.
- Knowledge of contract modeling systems such as FinThrive preferred.
- Knowledge of Access or SQL preferred.
Education/Experience:
- Bachelor’s degree required; emphasis in Accounting or Data Analytics preferred
- 2-5 years’ work experience required
- Prior experience in hospital, physician or health plan financial analysis, or equivalent experience preferred
- Knows/has modeled/worked with health plan/hospital and physician managed care commercial and Medicare reimbursement methodologies and terminology
Similar Jobs
Cloud • Computer Vision • Information Technology • Sales • Security • Cybersecurity
Manage data center financial operations through budgeting, variance analysis, financial modeling, month-end close reporting, cost-saving initiatives, and strategic analysis. The role requires data warehousing and modeling expertise, hardware and asset-management understanding, process improvement, automation, and effective communication with leadership and cross-functional partners.
Top Skills:
Artificial IntelligenceData ModelingData WarehousingExcelMicrosoft Powerpoint
.png){kind=logo}
AdTech • Cloud • Digital Media • Information Technology • News + Entertainment • App development
Supports budgeting, forecasting, monthly close, financial modeling, variance analysis, allocations, accruals, headcount reporting, purchase order management, and executive reporting for Engineering Finance. Partners with operational and cross-functional teams globally, maintains financial processes, and improves reporting and analysis to support business decisions.
Top Skills:
CopilotEssbaseExcelMS OfficeMicrosoft PowerpointSAP
Fintech • Mobile • Software • Financial Services
Manage strategic sourcing and procurement projects across financial services categories, including RFPs, renewals, supplier negotiations, benchmarking, spend analysis, and cost-saving initiatives. Partner with Legal, Finance, Risk, Compliance, Information Security, and business stakeholders to evaluate suppliers, negotiate commercial terms, manage contracts, monitor supplier performance, and ensure procurement governance. Prepare financial analyses, business cases, savings forecasts, and executive recommendations while managing multiple cross-functional projects.
Top Skills:
Contract-Management SystemsCoupaExcelGoogle SheetsIroncladProcurement SystemsVenminderWorkday
What you need to know about the Boston Tech Scene
Boston is a powerhouse for technology innovation thanks to world-class research universities like MIT and Harvard and a robust pipeline of venture capital investment. Host to the first telephone call and one of the first general-purpose computers ever put into use, Boston is now a hub for biotechnology, robotics and artificial intelligence — though it’s also home to several B2B software giants. So it’s no surprise that the city consistently ranks among the greatest startup ecosystems in the world.
Key Facts About Boston Tech
- Number of Tech Workers: 269,000; 9.4% of overall workforce (2024 CompTIA survey)
- Major Tech Employers: Thermo Fisher Scientific, Toast, Klaviyo, HubSpot, DraftKings
- Key Industries: Artificial intelligence, biotechnology, robotics, software, aerospace
- Funding Landscape: $15.7 billion in venture capital funding in 2024 (Pitchbook)
- Notable Investors: Summit Partners, Volition Capital, Bain Capital Ventures, MassVentures, Highland Capital Partners
- Research Centers and Universities: MIT, Harvard University, Boston College, Tufts University, Boston University, Northeastern University, Smithsonian Astrophysical Observatory, National Bureau of Economic Research, Broad Institute, Lowell Center for Space Science & Technology, National Emerging Infectious Diseases Laboratories
