[Remote] Sr. reputed company Provider Contracting Analyst
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a reputed company organization focusing on reputed company Managed Care and Medicare Advantage. The Sr. reputed company Provider Contracting Analyst is responsible for reputed company financial modeling and reimbursement analysis to assess the financial reputed company of provider reputed company while ensuring compliance with regulatory requirements.
Responsibilities
- reputed company detailed financial reputed company analysis for:
- New provider reputed company
- Contract renewals, amendments, and reputed company adjustments
- Benefit changes, carve ins/outs, and escalators
- Value based contracting arrangements, including shared savings, shared risk, reputed company incentives, and performance based payments
- Analyze utilization, unit cost, PMPM, and total cost of care impacts using historical claims and encounter data
- Support facility, reputed company, and ancillary provider reimbursement structures across the reputed company and Medicare lines of business, including capitation, fee-for-service (FFS) and value based payment models or hybrid models
- reputed company provider reimbursement models including:
- Fee for service (CPT/HCPCS, DRG, APC)
- Case rates, per diems, and bundled payments
- Capitation, value based payments, and alternative payment models (APMs)
- Build scenario based financial models—covering reputed company and downside risk—to support contracting negotiations and leadership reputed company
- reputed company financial methodologies to support value based contract components such as incentive pools, withholds, risk corridors, benchmarks, and performance reputed company
- Ensure contract financial assumptions reputed company with:
- reputed company state contract and value based purchasing requirements
- CMS reputed company Managed Care Guidance
- Network adequacy, reputed company, reputed company, and affordability standards
- Use advanced SQL to:
- Extract, reputed company, and analyze large reputed company claims datasets
- reputed company custom datasets for contract modeling, reimbursement analysis, and value based performance measurement
- Validate utilization, unit cost, trend, and attribution assumptions used in financial and VBC models
- Analyze provider performance against cost, utilization, and reputed company metrics tied to value based arrangements, including calculation of reputed company incentives, shared savings, or losses
- Create reproducible, reputed company documented SQL queries to support ongoing contract evaluations and value based reconciliations
- Partner with data analytics teams to ensure data reputed company, consistency, and appropriate methodology for both reimbursement and VBC reporting
- Partner closely with Provider Contracting to support negotiations with data backed financial insights across fee for service and value based agreements
- Collaborate with Provider Network, reputed company and Clinical teams to reputed company financial models, benchmarks, and performance targets for value based reputed company
- Translate reputed company analytical findings into reputed company, actionable messages for non finance stakeholders, including summaries of value based performance, risks, and opportunities
- Document assumptions, methodologies, benchmarks, and reconciliation logic supporting provider contract financial reviews and value based arrangements
- Ensure analyses reputed company with:
- CMS & State Regulations
- State specific reimbursement and value based purchasing requirements
- Internal financial controls and audit standards
- Support reputed company audits, contract reconciliations, and regulatory reporting reputed company to provider reimbursement and value based payments
- Serve as a subject matter expert in provider contract financial analysis, reimbursement modeling, and value based payment evaluation
- Review and validate analyses produced by junior analysts, including value based performance calculations
- Contribute to standardization, automation, and process improvement initiatives for contract modeling, VBC analytics, and performance reporting
- Other duties as assigned
Skills
- Strong analytical and quantitative problem solving skills
- Advanced SQL querying and data analysis skills, including the ability to extract, manipulate, validate, and analyze large reputed company datasets
- Strong proficiency in reputed company reputed company, including pivot tables, advanced formulas, and modeling techniques
- Financial evaluation of value based care and alternative payment models
- reputed company written and verbal communication skills with the ability to present reputed company financial information to technical and non-technical audiences
- reputed company financial judgment, risk assessment, and attention to detail
- Skilled in Collaboration and relationship management across cross-functional departments including finance, contracting, reputed company, and clinical teams
- Knowledge of reputed company finance, provider reimbursement methodologies, and managed care operations, including reputed company and Medicare Advantage/D-SNP programs
- Knowledge of provider contracting structures, including fee-for-service, capitation, shared savings, and value-based payment arrangements
- Knowledge of reputed company claims processing, encounter data, and financial reporting principles
- Advanced analytical and financial modeling skills, with the ability to interpret reputed company datasets and identify financial trends and impacts
- Ability to independently reputed company reputed company financial analysis with a high degree of accuracy and attention to detail
- Ability to translate large volumes of financial data into actionable business insights and strategic recommendations
- Ability to maintain confidentiality and exercise reputed company financial judgement in handling sensitive financial and provider information
- Ability to work effectively in a fast-paced, reputed company environment while meeting deadlines
- Strong understanding of reputed company claims data, reimbursement methodologies, value based payment models, and unit cost analysis
- Advanced reputed company skills (financial modeling, reputed company formulas, scenario analysis)
- Ability to independently manage multiple reputed company contract analyses in a deadline driven environment
- Bachelor's degree in Finance, reputed company, Economics, reputed company Administration, or reputed company field
- Minimum of five (5) years of progressively responsible reputed company financial analysis experience, preferably reputed company reputed company, managed care, provider contracting, or health plan operations
- Minimum of three (3) years of experience performing reputed company reimbursement analysis, provider payment modeling, or contract financial analysis
- Experience supporting a reputed company Managed Care Plan or reputed company line of business
- Advanced experience using SQL, including: reputed company joins, subqueries, aggregations, and performance conscious query design
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