Sr. Healthcare Provider Contracting Analyst
$120,970–$181,455 year
RemoteCalifornia, United States
Job Summary
Analyze the financial impact of new provider contracts, renewals, amendments, and reimbursement changes across Medicaid Managed Care and Medicare Advantage lines. Build financial models supporting fee-for-service, bundled payments, capitation, and value-based care arrangements, including scenario analyses for risk and performance evaluation. Utilize advanced SQL to extract, analyze, and validate large healthcare claims datasets, creating reports and tools to identify trends, opportunities, and areas of risk. Partner with Provider Contracting, Provider Relations, Finance, Quality, and Clinical teams to translate complex analyses into actionable business recommendations and support contract negotiations.
Required Qualifications
- Bachelor's degree in Finance, Accounting, Economics, Healthcare Administration, or a related field
- Five or more years of healthcare financial analysis experience within managed care, healthcare finance, provider contracting, or health plan operations
- Experience supporting Medicaid Managed Care and/or Medicare Advantage programs
- Strong understanding of provider reimbursement methodologies, including fee-for-service, capitation, and value-based payment models
- Advanced SQL experience with the ability to analyze large healthcare claims datasets
- Advanced Microsoft Excel skills, including financial modeling and scenario analysis
- Experience interpreting healthcare claims data and presenting financial findings to business leaders
- Strong analytical, communication, and problem-solving skills with the ability to manage multiple priorities in a collaborative environment
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