Senior Payer Analytics Consultant

Company: Central California Alliance for Health
Location: Scotts Valley
Posted on: November 15, 2024

Job Description:

We have an opportunity to join the Alliance as a Senior Payer Analytics Consultant in the Payment Strategy department.

Interested in learning more about this job Scroll down and find out what skills, experience and educational qualifications are needed.

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Payment Strategy Director, this position:

Performs complex managed care payer financial modeling and analysis to evaluate the feasibility of payer reimbursement methodologies
Conducts complex financial analysis to support successful payer reimbursement outcomes
Coordinates and collaborates with internal and external stakeholders to achieve payer reimbursement objectives
Provides subject matter expertise and assists with providing orientation, mentoring, and training to subordinate Payer Analytics Consultants

ABOUT THE TEAM

The Payment Strategy department ensures the Alliance's payments to our network are adequate to our revenue.

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirements click here.

Knowledge of:
Methods and techniques of financial modeling and analysis
Windows based PC systems and Microsoft Word, Outlook, PowerPoint, Access, Visual Basic, and Excel (including pivot tables), and database systems
Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers
Various types of health insurance payers, including Medicare, Medicaid, and commercial plans
Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider types
Healthcare financial statements and accounting principles
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
Assist with the orientation, training, and mentoring of other staff, as assigned
Education and Experience:
Bachelor's degree in Business Administration, Accounting, Finance, Healthcare, or a related field
A minimum of five 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

OTHER INFORMATION

We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

The full compensation range for this position is listed by location below.

The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).

OUR BENEFITS

Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance.

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
ABOUT US

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet.

The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer

At this time the Alliance does not provide any type of sponsorship. 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.

Keywords: Central California Alliance for Health, Woodland , Senior Payer Analytics Consultant, Accounting, Auditing , Scotts Valley, California