Payer Analytics Consultant – Defined Term

This is a fully remote position, open to applicants in California.

📋 Description

• Develops and validates managed care payer models and conducts moderately complex analyses to assess the viability of payer reimbursement methodologies.

• Performs moderately complex financial analyses to facilitate successful payer reimbursement outcomes.

• Collaborates and coordinates with both internal and external stakeholders to accomplish payer reimbursement goals.

⛳️ Requirements

• Bachelor’s degree in Business Administration, Accounting, Finance, Healthcare, or a similar field.

• At least three years of experience in performing financial healthcare reimbursement analysis (a Master’s degree may replace two years of the required experience); or an equivalent combination of education and experience may be acceptable.

• Proficiency in:

• Windows-based PC systems along with Microsoft Word, Outlook, PowerPoint, Access, Visual Basic, and Excel (including pivot tables), and database systems.

• Financial modeling and analysis methods and techniques.

• Principles and practices governing provider reimbursement methodologies, pricing, and fee schedules across all provider types, including hospitals, physicians, and ancillary providers.

• Healthcare industry-specific terminology and healthcare-related data types and structures, encompassing member, claims, clinical, and provider categories.

• National standards for fee-for-service and value-based provider reimbursement methodologies, including risk-sharing models.

• Data modeling techniques along with business analytical and data mining tools, such as SQL, and data visualization tools like Tableau.

• Capability to:

• Collect, interpret, and assess data, recognize patterns, brainstorm solutions, consider various factors in decision-making, and anticipate the implications of recommendations.

• Exhibit strong analytical, critical thinking, and research abilities, identify and resolve issues, explore alternative solutions, and propose actionable recommendations.

• Convert data into clear information and provide solutions that enhance business processes.

• Serve as a technical resource, offering guidance related to the area of assignment, and clarifying relevant regulations, processes, and programs.

• Interpret and apply rules, regulations, policies, procedures, and guidelines.

• Work collaboratively with individuals at all organizational levels while supporting multiple stakeholders.

🏝️ Benefits

• Medical, Dental, and Vision Plans.

• Generous Paid Time Off.

• 12 Paid Holidays each year.

• 401(a) Retirement Plan.

• 457 Deferred Compensation Plan.

• Comprehensive Health and Wellness Program.

• Onsite EV Charging Stations.