Note: The job is a remote job and is open to candidates in USA. Central California Alliance for Health is hiring a Payer Analytics Consultant to design and validate managed care payer models and assess reimbursement methodologies. The role conducts financial analysis and collaborates with stakeholders to support payer reimbursement objectives.

Responsibilities

• Designs and validates managed care payer models and performs moderately complex analysis to evaluate the feasibility of payer reimbursement methodologies
• Conducts moderately complex financial analysis to support successful payer reimbursement outcomes
• Coordinates and collaborates with internal and external stakeholders to achieve payer reimbursement objectives

Skills

• Knowledge of:
• Windows based PC systems and Microsoft Word, Outlook, PowerPoint, Access, Visual Basic, and Excel (including pivot tables), and database systems
• Methods and techniques of financial modeling and analysis
• Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers
• Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider types
• National standards for fee-for-service and value-based provider reimbursement methodologies, including risk-sharing models
• Data modeling techniques and business analytical and data mining tools, including SQL, and data visualization tools, such as Tableau
• Ability to:
• Collect, interpret, and evaluate data, detect patterns, brainstorm solutions, consider multiple factors when making decisions, and project consequences of recommendations
• Demonstrate strong analytical, critical thinking, and research skills, identify and troubleshoot issues, identify alternative solutions, and make recommendations for action
• Translate data into understandable information and deliver solutions that improve business processes
• Act as a technical resource, provide guidance related to area of assignment, and explain related regulations, processes, and programs
• Interpret and apply rules, regulations, policies, procedures, and guides
• Work collaboratively with individuals at all levels of the organization while supporting multiple stakeholders
• Bachelor's degree in Business Administration, Accounting, Finance, Healthcare, or a related field
• A minimum of three years of experience performing financial healthcare reimbursement analysis (a Master's degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying
• Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship
• Technically strong, with proven experience in payer financial modeling, provider payment methodologies, payment structure design, and reimbursement strategy development
• Analytical and detail-oriented, skilled in data interpretation, trend analysis, and scenario modeling to inform decision-making and optimize payment accuracy
• Collaborative and solutions-focused, working effectively across departments — including finance, provider network management, operations, and clinical teams — to align analytics with business goals
• A clear and professional communicator, able to explain complex financial and analytical concepts to both technical and non-technical audiences
• Relationship-driven, fostering productive partnerships with internal stakeholders and external partners to support shared priorities and ensure alignment
• Curious and improvement-minded, continuously seeking opportunities to enhance data quality, streamline processes, and support innovative payment strategies

Benefits

• Medical, Dental and Vision Plans (available for regular Alliance employees working more than 30 hours per week; some benefits are available on a pro-rated basis for part-time employees; unavailable to temporary employees while on an assignment with the Alliance)
• Ample Paid Time Off (available for regular Alliance employees working more than 30 hours per week; some benefits are available on a pro-rated basis for part-time employees; unavailable to temporary employees while on an assignment with the Alliance)
• 12 Paid Holidays per year (available for regular Alliance employees working more than 30 hours per week; some benefits are available on a pro-rated basis for part-time employees; unavailable to temporary employees while on an assignment with the Alliance)
• 401(a) Retirement Plan (available for regular Alliance employees working more than 30 hours per week; some benefits are available on a pro-rated basis for part-time employees; unavailable to temporary employees while on an assignment with the Alliance)
• 457 Deferred Compensation Plan (available for regular Alliance employees working more than 30 hours per week; some benefits are available on a pro-rated basis for part-time employees; unavailable to temporary employees while on an assignment with the Alliance)
• Robust Health and Wellness Program (available for regular Alliance employees working more than 30 hours per week; some benefits are available on a pro-rated basis for part-time employees; unavailable to temporary employees while on an assignment with the Alliance)
• Onsite EV Charging Stations (available for regular Alliance employees working more than 30 hours per week; some benefits are available on a pro-rated basis for part-time employees; unavailable to temporary employees while on an assignment with the Alliance)
• Hybrid work environment; some staff may work full telecommuting schedules
• This Defined Term role is a fully benefited position

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