Managed Care Contracting Analyst

At Augusta Health, your work matters — and so do you. Whether you're delivering direct patient care, supporting operations, or innovating behind the scenes, every role contributes to our mission of promoting wellness and healing through compassionate service. We offer more than just a job — we offer a purpose-driven career in a nationally recognized, independent health system located in Virginia’s scenic Shenandoah Valley.

Learn more about career opportunities on our Careers Page.

Our team members thrive in a supportive culture that values collaboration, integrity, and excellence. With opportunities across clinical and non-clinical areas, Augusta Health is a place where your skills make a difference, and your growth is a priority.

• Contract Modeling & Financial Analysis
  
  • Build and maintain financial models of current and proposed payer rates, terms, and payment methodologies to quantify net revenue impact.
  • Perform what-if modeling of alternative rate proposals, payment methodologies, and utilization scenarios in support of negotiation strategy.
  • Analyze claims, charge, and reimbursement data to develop payer-specific baselines, trends, and benchmarks.
  • Prepare rate comparisons, yield analyses, and payer scorecards for use in negotiations and executive reporting.
  • Support budgeting and forecasting with projected impacts of rate changes, payer mix shifts, and new agreements.
• Payer Performance Monitoring
  
  • Monitor executed contracts on an ongoing basis, comparing expected to actual reimbursement and identifying payment variances and underpayments.
  • Research root causes of payment variances and coordinate with Revenue Cycle to pursue recoveries and corrections.
  • Track payer policy changes, fee schedule updates, and contract amendments, and assess their financial and operational impact.
  • Maintain key performance indicators and dashboards for contract yield, payer mix, denials, and payment timeliness.
  • Prepare recurring contract performance reports for the Director, CFO, and other stakeholders.
• Negotiation & Strategy Support
  
  • Prepare data, models, exhibits, and briefing materials in support of payer negotiations led by the Director.
  • Evaluate payer proposals and counterproposals, quantifying financial impact and identifying unfavorable terms.
  • Assist in developing negotiation targets, priorities, and renewal calendars for the managed care contract portfolio.
  • Support analyses requested by external managed care consultants and advisors, and incorporate their benchmarking into internal work products.
  • Attend payer meetings and negotiations as requested, documenting outcomes and follow-up items.
• Contract Administration & Data Management
  
  • Maintain a centralized repository of executed agreements, amendments, rate exhibits, and key contract terms.
  • Track contract effective dates, renewal dates, termination windows, and notice requirements to prevent lapses or unfavorable auto-renewals.
  • Summarize key contract provisions and communicate rate and term changes to Revenue Cycle, Patient Access, and other affected departments.
  • Support accurate loading and implementation of contract terms in applicable systems, validating expected reimbursement calculations.
  • Ensure data governance, quality, and integrity standards are maintained across contract models and reporting.
  • Document modeling methodologies, assumptions, and data sources to ensure analyses are reproducible and auditable.
• Issue Resolution & Collaboration
  
  • Research and support resolution of escalated payer issues involving payment promptness, denials, authorizations, credentialing, and payer-member concerns.
  • Collaborate with Revenue Cycle, Finance, and Population Health to ensure reported data is reliable and issues are addressed timely.
  • Respond to information requests from external auditors, consultants, and payers as directed.
  • Provide analytical support for value-based care arrangements, including performance tracking against quality and cost targets.
• Regulatory & Market Intelligence
  
  • Maintain current knowledge of federal and state regulations affecting managed care, including CMS requirements, price transparency, and the No Surprises Act.
  • Monitor market trends, payer product developments, and competitor activity to inform strategy recommendations.
  • Support compliance with contract-related regulatory reporting and documentation requirements.
• Professional Development & Culture
  
  • Model Augusta Health’s values and contribute to a collaborative, results-oriented team culture.
  • Pursue continuous learning in managed care, reimbursement, and analytics through professional development opportunities.
  • Identify and recommend process improvements to enhance the accuracy and efficiency of contracting analyses.
  • Participate in professional associations and peer networks related to healthcare finance and managed care as appropriate.

• Education: Bachelor’s degree in Finance, Accounting, Business Administration, Healthcare Administration, Economics, Mathematics, or a related field; or an equivalent combination of education and relevant analytical experience
• Licensure/Certification: None
• Experience: 
  • Three (3) years of progressive experience in healthcare finance, managed care, revenue cycle, decision support, or payer analytics.
  • Demonstrated experience building financial models and analyses in Excel, including reimbursement, rate, or net revenue modeling.
  • Experience working with healthcare claims, charge, or reimbursement data and interpreting payer contract terms.
  • Demonstrated ability to present analytical findings clearly to non-technical audiences.
• Driver’s License: N/A
• Eligibility to work in the United States and meet Virginia state employment requirements

• Education: 
  • Master’s degree (MBA, MHA, MSF, or equivalent)
  • Coursework or formal training in healthcare finance, statistics, or data analytics
• Licensure/Certification: 
  • Certified Revenue Cycle Representative (CRCR) or Certified Healthcare Financial Professional (CHFP) through HFMA
  • Certified Public Accountant (CPA)
  • Lean Six Sigma Green Belt
  • Membership in HFMA or comparable professional associations
• Experience: 
  • Experience supporting managed care contract negotiations within a hospital, health system, or payer organization.
  • Experience with contract modeling tools, decision support systems, or healthcare data warehouses (e.g., Meditech Data Repository, SQL, Power BI, or similar).
  • Working knowledge of value-based care arrangements and alternative payment models.
  • Experience working within an independent community health system or similarly complex healthcare organization.
• Prior experience in a hospital, healthcare system, or related service-oriented environment
• Familiarity with Augusta Health’s systems, workflows, or organizational culture is a plus

• Strong knowledge of healthcare reimbursement methodologies, including DRG, per diem, fee schedule, percent-of-charge, and value-based payment models.
• Advanced Excel skills, with the ability to build, maintain, and quality-check complex contract and reimbursement models.
• Proficiency with data analysis and reporting tools (e.g., SQL, Power BI, or similar) and the ability to work with large claims and charge datasets.
• Strong analytical and critical thinking skills, with attention to detail and a commitment to data accuracy and integrity.
• Ability to read and interpret managed care contract language, rate exhibits, and payer policies.
• Working knowledge of federal and state regulations affecting managed care, including CMS requirements, price transparency, and the No Surprises Act.
• Excellent written and verbal communication skills, with the ability to translate technical analyses into clear recommendations.
• Strong organizational and project management skills, with the ability to manage multiple priorities and deadlines.
• Ability to work collaboratively with Revenue Cycle, Finance, Population Health, and payer representatives to research and resolve issues.
• Ability to handle confidential information with discretion and sound judgment.
• Self-directed, curious, and committed to continuous learning and process improvement.

Augusta Health is an independent, nonprofit, mission-driven health system located in Fishersville, Virginia, in the heart of the Shenandoah Valley. We offer a full continuum of inpatient and outpatient services, including Augusta Medical Center—a 255-bed facility—and Augusta Medical Group, which operates 40 practice locations and four urgent care centers. Our commitment to excellence, innovation, and compassionate care makes Augusta Health a leading employer and healthcare provider in the region.

Discover more about our history, values, and community impact on our About Us Page.

Augusta Health recruits, hires, and promotes qualified candidates for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran or military discharge status, and family medical or genetic information.

We are committed to fostering a diverse and inclusive workplace in accordance with federal and Virginia state employment laws.