While candidates from anywhere in California are welcome to apply, there is a strong preference for those who reside on the Central Coast (Ventura, Santa Barbara, San Luis Obispo, Monterey and Santa Cruz Counties). This role may offer opportunities for remote work; however, familiarity with and proximity to our local customers is valued.

We are seeking a highly analytical and strategic Sr. Healthcare Provider Contracting Analyst to support the financial performance and reimbursement strategy of our Medicaid Managed Care and Medicare Advantage D-SNP health plans. This role is ideal for a healthcare finance professional with deep expertise in provider reimbursement, advanced SQL analytics, and value-based care modeling.

As a key subject matter expert, you will lead complex provider contract financial analysis, reimbursement rate development, and value-based payment modeling while partnering closely with Provider Contracting, Quality, Clinical, and Data Analytics teams to support data-driven decision-making and affordability initiatives.

What You’ll Do Provider Contract Financial Analysis

• Perform detailed financial impact analyses for:
• New provider contracts
• Contract renewals and amendments
• Rate adjustments and benefit changes
• Value-based payment arrangements including shared savings, shared risk, and quality incentives
• Analyze utilization, PMPM, unit cost, and total cost of care trends using healthcare claims and encounter data
• Support reimbursement structures across Medicaid and Medicare lines of business including:
• Fee-for-service (FFS)
• Capitation
• Value-based and hybrid payment models

Rate Development & Financial Modeling

• Develop reimbursement methodologies including:
• CPT/HCPCS, DRG, and APC fee schedules
• Case rates, bundled payments, and per diems
• Capitation and alternative payment models (APMs)
• Build complex scenario-based financial models to support provider negotiations and executive decision-making
• Design methodologies for:
• Incentive pools
• Risk corridors
• Withholds
• Shared savings/losses
• Performance benchmarks and thresholds
• Ensure all models align with CMS guidance, Medicaid managed care requirements, network adequacy standards, and affordability goals

Advanced SQL & Healthcare Data Analytics

• Use advanced SQL to extract, transform, validate, and analyze large healthcare claims datasets
• Develop custom datasets for:
• Contract modeling
• Reimbursement analysis
• Value-based performance measurement
• Analyze provider performance against quality, utilization, and cost metrics
• Create reproducible and well-documented SQL queries and reporting methodologies
• Partner with Data Analytics teams to ensure data integrity and reporting accuracy

Strategic Collaboration & Leadership

• Support provider contract negotiations with data-backed financial insights
• Collaborate cross-functionally with Provider Network, Quality, Clinical, and Finance teams
• Present complex analytical findings in a clear and actionable manner to technical and non-technical audiences
• Serve as a mentor and subject matter expert for junior analysts
• Drive process improvements, automation, and standardization initiatives

What We’re Looking For Required Qualifications

• Bachelor’s degree in Finance, Accounting, Economics, Healthcare Administration, or related field
• Minimum 5 years of healthcare financial analysis experience
• Minimum 3 years of provider reimbursement, payment modeling, or provider contract financial analysis experience
• Experience supporting Medicaid Managed Care or Medicaid lines of business
• Advanced SQL experience including:
• Complex joins
• Subqueries
• Aggregations
• Query optimization and performance-conscious design

Apply today and help shape the future of healthcare reimbursement and provider partnerships.

Pay: $120,970.00 - $181,455.00 per year

Benefits:

• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Paid time off
• Professional development assistance
• Referral program
• Retirement plan
• Vision insurance

Work Location: Remote