Payer Analytics Consultant – Defined Term

🕒 May 21

🏄 California – Remote

🏄 California – Remote

💵 $125k - $140k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

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Central California Alliance for Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1996

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare Insurance • Non-profit

Central California Alliance for Health is a regional non-profit healthcare organization that provides Medi-Cal managed care services to residents in several Central California counties, including Mariposa, Merced, Monterey, San Benito, and Santa Cruz. The organization offers a wide range of health services, including primary care, behavioral health, pharmacy support, and disease management, focusing on improving member coordination of care and access to health services. Central California Alliance for Health also engages with communities through grants and partnerships to enhance healthcare accessibility and quality. The organization supports members with services such as dental and vision care, family planning, transportation, and language assistance. Additionally, it provides resources for health education, telehealth services, and complex case management.

📋 Description

• 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

🎯 Requirements

• 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 • 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

🏖️ Benefits

• Medical, Dental and Vision Plans • Ample Paid Time Off • 12 Paid Holidays per year • 401(a) Retirement Plan • 457 Deferred Compensation Plan • Robust Health and Wellness Program • Onsite EV Charging Stations