Payer Analytics Consultant

October 28

🏄 California – Remote

Although this job is listed in California, this company may be open to hiring remote in other states.

💵 $97.9k - $156.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

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Central California Alliance for Health

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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.

501 - 1000 employees

Founded 1996

⚕️ Healthcare Insurance

🤝 Non-profit

📋 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 • Knowledge of methods and techniques of financial modeling and analysis • Knowledge of principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers • Knowledge of healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider types • Knowledge of national standards for fee-for-service and value-based provider reimbursement methodologies, including risk-sharing models • Knowledge of 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 • Ability to demonstrate strong analytical, critical thinking, and research skills, identify and troubleshoot issues, identify alternative solutions, and make recommendations for action • Ability to translate data into understandable information and deliver solutions that improve business processes • Ability to act as a technical resource, provide guidance related to area of assignment, and explain related regulations, processes, and programs • Ability to interpret and apply rules, regulations, policies, procedures, and guides • Ability to 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 • And many more