Job Description

Responsibilities:

Prepare advanced reimbursement, financial impact, and performance analyses to support managed care contract negotiations and payer strategy.
Design and evaluate value-based payment models, including shared savings, quality metrics, risk corridors, and attribution methodologies.
Conduct pro forma and sensitivity analyses to estimate the financial value of proposed contract changes, cost containment initiatives, and industry trends.
Conduct sensitivity analyses and stress testing on models to understand the range of potential outcomes under multiple utilization and cost scenarios.
Monitor and analyze contract and value-based program performance, identify underpayments, compliance gaps, or unfavorable payment trends, and financial risks.
Develop monthly forecases and financial packages summarizing value-based performance, payment reconciliation, and variance analysis.
Conduct quarterly and annual reconciliation audits for value-based programs, ensuring payer compliance with contractual terms and identifying areas of non-compliance affecting contract performance.
Develop and implement innovative tools and methodologies to monitor healthcare trends to accurately forecast value-based performance.
Synthesize insights from payer data, market trends, and industry developments to inform negotiation strategy and enterprise decision-making.
Create executive-ready visualizations for contract performance and financial forecasting tailored to different stakeholder audiences (clinical vs. financial). Build repeatable analytic processes that scale across programs.
Mentor Managed Care Analysts, provide technical guidance, and contribute to analytical standards and process improvements within the team.

Qualifications:

Bachelor's degree in STEM field: e.g. Economics, Actuarial Science, Health Economics, Business Administration, Finance, Accounting, Healthcare Administration, , or related discipline
5+ years of progressive experience in healthcare finance, payer analytics, medical economics, or related healthcare consulting
Demonstrable track record of building analytics that drive business decisions and actions.
Demonstrated experience supporting value-based contract development, including performance measurement, attribution/quality metrics, reconciliation, and dispute resolution/appeals processes
Experience with forecasting, audit, and predictive analytics. to support negotiation and contract performance management
Advanced proficiency in SQL, Tableau, and/or Power BI.
Demonstrated experience extracting, validating, and analyzing large healthcare claims, reimbursement, and/or value-based performance datasets
Strong communication skills with the ability to translate complex data into strategic insights for both technical and non-technical audiences