Alumni Spotlight: Astrid C. Del Rosario (MHA 2024)

Astrid C. Del Rosario (MHA 2024), managed care contract analyst, Valley Health System

As a Managed Care Contract Analyst at Valley Health System, what are your main responsibilities, and how do they impact the healthcare system?

As a Managed Care Contract Analyst, I oversee and negotiate NSA (No Surprises Act) claims, ensuring compliance and securing optimized reimbursement. My responsibilities also include assessing payer policies, conducting in-depth research on CPT and revenue codes, and analyzing the financial implications of these policies to shape effective reimbursement strategies. I track high-dollar surgical cases and new technologies to maintain financial and operational oversight.

In addition to these duties, I provide comprehensive oversight of payer contract compliance across the system, ensuring adherence to all relevant policies and regulations. I am also a key resource for system stakeholders, offering expertise on new regulatory and legislative developments, particularly those related to the Federal Price Transparency and the No Surprises Act.

Moreover, I provide analytical support to areas such as Valley Medical Group (VMG), Population Health, and ColigoCare, assisting with revenue forecasting, contract modeling, and analyzing denial and payment variances. As a subject matter expert on insurance industry changes, managed care regulations, and payer policy updates, I help educate teams across the system and ensure alignment with evolving industry standards.

Through these efforts, I contribute to optimizing the financial health of the healthcare system, ensuring regulatory compliance, and providing transparency to stakeholders. Ultimately, these activities enhance the system’s ability to deliver high-quality care while effectively managing costs.

What are some key challenges you face when negotiating and analyzing managed care contracts, and how do you navigate them?

One of the primary challenges I face when negotiating and analyzing managed care contracts is the complexity and constant evolution of payer policies and reimbursement structures. These policies can change frequently, making it crucial to stay informed and adapt to new regulations and industry trends. Navigating these changes requires thorough research and a deep understanding of the financial implications of each policy. Additionally, ensuring that reimbursement rates align with the financial needs of the organization, while balancing the expectations of payers, presents an ongoing challenge.

Another challenge is addressing the discrepancies in claims and payments. Denials and payment variances are common, and resolving these issues requires detailed analysis of the underlying causes and effective communication with payers. This often involves cross-functional collaboration with teams in legal, finance, and operational areas to address and resolve these issues efficiently.

To navigate these challenges, I rely on a combination of strategic thinking, data-driven analysis, and strong communication skills. I maintain close relationships with key stakeholders, including payers and internal teams, to ensure alignment and open dialogue. By staying proactive in identifying trends, analyzing data, and educating stakeholders, I am able to mitigate risks and ensure that the organization’s managed care contracts are both compliant and financially beneficial.

What course or experience from your time at Wagner has been the most helpful or inspiring in your work?

Although all the courses and experiences I had at Wagner left an extraordinary impact on my work today, the most impactful experience was learning how to collaborate effectively within teams. In the Managing Healthcare Organizations course, we participated in the Mount Everest simulation, which emphasized the challenges of working with individuals who may not be at the same level of understanding or expertise, along with other obstacles that can arise in team settings. This experience taught me the importance of clear communication, patience, and collaboration to achieve optimal outcomes. I apply these lessons daily in my current role, where I often rely on my peers for support and expertise when needed. I’ve learned that teamwork and open communication are crucial to solving complex problems and driving success. This collaborative mindset has proven invaluable in navigating the complexities of managed care contracts and ensuring that all stakeholders are aligned and informed.

What advice would you give to students interested in pursuing a career in healthcare administration?

I would advise students to focus on developing the ability to think strategically and make decisions grounded in facts and data, rather than emotion. A career in healthcare administration requires a keen understanding of both the financial health of an organization and the patient experience. It is essential to think analytically and have a strong grasp of your organization’s mission, vision, and values. By aligning your efforts with these core principles, you can contribute to the long-term success of the organization. Furthermore, cultivating the ability to make informed, evidence-based decisions will be invaluable in addressing the complexities and challenges inherent in healthcare administration.