Contract Operations Analyst

$90,000 - $90,000/Yr

Metroplus Health Plan - New York, NY

Full-time - Mid Level

New York, NY

Professional, Scientific, and Technical Services

About the position

The Contract Operations Analyst position at MetroPlusHealth is designed to provide critical analysis and oversight of processes related to the assessment, building, and ongoing maintenance of providers, groups, and Independent Practice Associations (IPAs) for both new and existing contracts. This role is pivotal in ensuring that the organization can effectively monitor and enhance its provider network, which is essential for the strategic growth and contracting initiatives of the health plan. The analyst will engage in intra-departmental communication and collaboration with various teams, including Contracting, Credentialing, Provider Network Operations, and IT Staff, to ensure a cohesive approach to network management. In this role, the analyst will be responsible for generating a variety of reports and assessments that evaluate the performance of the provider network, focusing on utilization, financial metrics, and quality indicators. These reports will play a crucial role in shaping how the plan interacts with its network on an ongoing basis. Additionally, the analyst will assess systems data to ensure alignment between credentialing systems and primary claims systems, facilitating a smooth provider experience. The position also requires the documentation and continuous improvement of processes to adapt to new systems and enhance operational efficiency. The Contract Operations Analyst will perform detailed analyses on individual providers, groups, IPAs, and contracted vendors, examining historical network performance in relation to risk, utilization, financials, and quality performance. The role involves reviewing external provider rosters to identify growth opportunities and assessing reimbursement rates. The analyst will also report on the performance of current contractual arrangements and model proposed changes, ensuring that any issues related to provider or vendor configuration errors within the claims system are identified and reconciled. Collaboration with other departments is essential to ensure accurate representation of providers in the primary claims system, and the analyst will be responsible for building out process documentation to improve transparency and accountability across various steps and departments.

Responsibilities

• Perform analysis on individual providers, groups, IPAs, and contracted vendors related to historical network performance.
• Assess external provider rosters for current network overlap and growth opportunities.
• Review fee schedules set by CMS and NYSDOH for accurate representation in contractual arrangements.
• Report on performance of current contractual arrangements and model proposed changes.
• Identify and reconcile issues due to provider or vendor configuration errors within the claims system.
• Collaborate with other departments to ensure accurate representation in the primary claims system.
• Build out process documentation to improve the provider build process and implement checks and balances.
• Stay informed of new and upcoming changes to arrangements and adjust accordingly.
• Prepare analyses of contracted services from large, shared databases utilizing queries and externally provided data.
• Support staff on various initiatives related to value-based payment arrangements, provider contracts, finance, risk, and quality.
• Work on special projects as needed and assist in various areas of contracting.

Requirements

• Bachelor's degree or equivalent experience required.
• 2+ years of claims, health care provider payment methods, and billing configuration experience.
• Intermediate to advanced experience with MS SQL, Excel, or other programming/query languages.
• Experience working with large data systems.
• Proven ability to apply quantitative and/or qualitative research and data analysis techniques to improve operational processes.
• Experience with claims data as it pertains to the healthcare industry.
• Ability to build and foster relationships at all levels of the organization.

Nice-to-haves

• Experience in a healthcare analytics role.
• Familiarity with value-based payment models.
• Knowledge of healthcare regulations and compliance standards.

Benefits

• Competitive salary of $90,000 annually.
• Comprehensive health insurance coverage.
• Retirement savings plan options.
• Opportunities for professional development and training.