Director, Payor Contract Analytics - Kelsey - Seybold Clinics, Pearland TX.

UnitedHealth Group•Pearland, TX

2d•$112,700 - $193,200•Onsite

About The Position

The Payor Contracting Analytics Director serves as an analytical leader responsible for driving the financial, analytical, and operational components of Kelsey Seybold’s payer contracting strategy. This role oversees complex reimbursement modeling and partners cross functionally to ensure successful contract negotiations and implementation of new agreements. The Payor Contracting Analytics, Director plays a critical role in shaping the organization’s capitation and value-based care portfolio, identifying opportunities for growth, and ensuring financial sustainability across all contract types. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Requirements

10+ years of Health Care or Health Plan analytical experience
Extensive experience with SQL servers, SAP, data management systems, including but not limited to Excel, Access, and Microsoft Data Services.
Knowledge of CMS rules and regulations, Managed Care payment methodologies, and proficient in MS office products, and Power BI
Experience working with claims and large healthcare datasets and solid understanding of payer financial models and cost structures
Experience applying AI enabled analytics tools (e.g., automated insights, predictive modeling, and intelligent reporting features within platforms such as Power BI or SQL based environments) to support healthcare financial analysis and decision making
Healthcare & Texas Market knowledge with a solid understanding of Medicare Advantage Reimbursement and risk adjustment, ACA Marketplace dynamics, capitation and value-based models.
Understanding of: Provider reimbursement methodologies (e.g., %25 of Medicare, DRG, case rates)
Proven excellent written and verbal communication skills, solid analytical and problem-solving abilities and high attention to detail

Nice To Haves

EPIC
Experience with Power BI or equivalent business intelligence / dashboarding tools to support reporting and visualization needs
Experience supporting or analyzing value-based care arrangements, including shared savings and shared risk models
Experience analyzing reimbursement as a percentage of CMS/Medicare rates
Experience within healthcare payer/provider contracting (medical groups, health plans, ASC, or similar)
Experience evaluating high-cost drugs or capitation carve-out decisions
Direct experience leading financial modeling for capitation (professional, global, or POP-based contracts)
Solid understanding of Medicare Advantage payment structures and reimbursement methodologies, including revenue drivers tied to MA plans
Demonstrated ability to apply data analytics within payer contracting environments, including working with large datasets and translating insights into financial or strategic recommendations
Have supported or led modeling/negotiations for value-based care contracts (shared savings, shared risk)
Have led projects or teams responsible for contract strategy, financial analysis, or payer negotiations (manager-level or higher)
Have led or owned implementation of payer/provider contracts across cross-functional teams (Finance, IT, Claims, Ops)
Have used transparency/vendor rate data for negotiation strategy

Responsibilities

Driving the financial, analytical, and operational components of Kelsey Seybold’s payer contracting strategy.
Overseeing complex reimbursement modeling.
Partnering cross functionally to ensure successful contract negotiations and implementation of new agreements.
Shaping the organization’s capitation and value-based care portfolio.
Identifying opportunities for growth.
Ensuring financial sustainability across all contract types.