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The Managed Care Analyst plays a key role in advancing Beacon's data-driven decision-making by delivering high-impact financial, operational, and value-based analytics. This role primarily supports Beacon Managed Care, including Accountable Care Organizations (ACO), and Medicare Shared Savings Program (MSSP) initiatives.
The position blends financial and data analysis, regulatory compliance, contract modeling, and value-based reporting, requiring strong analytical judgment, technical aptitude, and cross-functional collaboration.
MISSION, VALUES and SERVICE GOALS
MISSION: We deliver outstanding care, inspire health, and connect with heart.
VALUES: Trust. Respect. Integrity. Compassion.
SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.
Key Responsibilities
Financial, Operational & Value Based Analytics
Develop, distribute, and support recurring and ad hoc financial and operational reports related to Beacon Managed Care, ACOs, MSSP performance, and value-based initiatives.
Partner with business users to interpret financial results, performance trends, benchmarks, and assumptions.
Produce scenario-based financial analyses and recommendations supporting strategic planning and decision-making.
Support financial evaluations of proposed contracts, payer arrangements, and programs by interpreting contractual language and modeling financial impact.
Contribute to the development of a data-informed culture by presenting insights, identifying risks and opportunities, and proposing data-driven solutions.
Document all deliverables, including methodologies, assumptions, data sources, and user requirements to ensure repeatability, transparency, and audit readiness.
Participate with cross-functional teams on projects such as payor data feeds (incoming and outgoing), Oracle HDI set up and file transfers related to managed care and ACO.
Meet deadlines by prioritizing reoccurring reporting requirements and ad-hoc report requests
Medicare Shared Savings Program (MSSP) Compliance Responsibilities
Serve as a key analytical and operational support resource to ensure Beacon's ongoing compliance with CMS Medicare Shared Savings Program (MSSP) requirements.
Support monitoring and reporting of MSSP financial performance, benchmarks, expenditures, and shared savings calculations in alignment with CMS guidance.
Assist in preparing and validating data, reports, and documentation required for CMS submissions, audits, and reconciliations related to ACO participation.
Ensure analytical methodologies, assumptions, and reporting outputs align with MSSP regulations, program rules, and contractual ACO obligations.
Partner with Managed Care, Finance, Compliance, Quality, and Value based Health teams to identify compliance risks, data discrepancies, and performance trends impacting MSSP outcomes.
Escalate potential compliance concerns, data integrity issues, or regulatory changes impacting MSSP participation to leadership as appropriate.
Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by:
Completing other job-related duties as assigned and special projects as directed.
QUALIFICATIONS
Education and Experience
The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a bachelor's degree in finance, Business, Analytics, Healthcare Administration, or a related field. Minimum of 2 years' professional experience creating financial analysis, contract performance analysis, reports and dashboards, and data driven recommendations, preferably in a healthcare setting.
Knowledge & Skills
Requires strong analytical, organizational, and communication skills to collect, analyze, and deliver accurate, time sensitive insights in a fast paced healthcare environment. Demonstrates proficiency in financial and managed care concepts, value based reimbursement models, and tools such as Excel and PowerPoint. Capable of working independently in ambiguous situations, prioritizing multiple initiatives, leading data driven projects, and collaborating effectively across all levels and departments of the health system.
ORGANIZATIONAL RESPONSIBILITIES
Completes mandatory education, annual competencies and department specific education within established timeframes.
Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
Adheres to regulatory agency requirements, survey process and compliance.
Complies with established organization and department policies.
Available to work overtime in addition to working additional or other shifts and schedules when required.
Working Conditions
Works in an office environment.
May be required to vary hours and days, and work on holidays, weekends, etc., depending upon the needs of the department.
Physical Demands
Requires physical ability and stamina to perform the essential functions of the position.