Payer Analytics Consultant (Defined Term)

Central California Alliance for Health (Remote)•Remote, California, CA

2d•$118,000 - $140,000•Hybrid

About The Position

This Defined Term position is designated by the Alliance and is a position of limited duration. Defined Term employees are usually hired to work in a specific department on specific long-term project work until the work is completed or to a specific end date not to exceed December 31, 2026. This Defined Term role is a fully benefited position. This position can be filled within any of our Alliance service areas, or remotely within the Pacific, Mountain and Central time zones. The Payment Strategy department ensures the Alliance's payments to our network are adequate to our revenue. We also work to advance our payment methodology in order to achieve the best quality healthcare while reducing costs.

Requirements

Knowledge of Windows based PC systems and Microsoft Word, Outlook, PowerPoint, Access, Visual Basic, and Excel (including pivot tables), and database systems
Knowledge of Methods and techniques of financial modeling and analysis
Knowledge of Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers
Knowledge of Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider types
Knowledge of National standards for fee-for-service and value-based provider reimbursement methodologies, including risk-sharing models
Knowledge of Data modeling techniques and business analytical and data mining tools, including SQL, and data visualization tools, such as Tableau
Ability to Collect, interpret, and evaluate data, detect patterns, brainstorm solutions, consider multiple factors when making decisions, and project consequences of recommendations
Ability to Demonstrate strong analytical, critical thinking, and research skills, identify and troubleshoot issues, identify alternative solutions, and make recommendations for action
Ability to Translate data into understandable information and deliver solutions that improve business processes
Ability to Act as a technical resource, provide guidance related to area of assignment, and explain related regulations, processes, and programs
Ability to Interpret and apply rules, regulations, policies, procedures, and guides
Ability to Work collaboratively with individuals at all levels of the organization while supporting multiple stakeholders
Bachelor’s degree in Business Administration, Accounting, Finance, Healthcare, or a related field
A minimum of three 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

Nice To Haves

Technically strong, with proven experience in payer financial modeling, provider payment methodologies, payment structure design, and reimbursement strategy development.
Analytical and detail-oriented, skilled in data interpretation, trend analysis, and scenario modeling to inform decision-making and optimize payment accuracy.
Collaborative and solutions-focused, working effectively across departments — including finance, provider network management, operations, and clinical teams — to align analytics with business goals.
A clear and professional communicator, able to explain complex financial and analytical concepts to both technical and non-technical audiences.
Relationship-driven, fostering productive partnerships with internal stakeholders and external partners to support shared priorities and ensure alignment.
Curious and improvement-minded, continuously seeking opportunities to enhance data quality, streamline processes, and support innovative payment strategies.

Responsibilities

Designs and validates managed care payer models and performs moderately complex analysis to evaluate the feasibility of payer reimbursement methodologies
Conducts moderately complex financial analysis to support successful payer reimbursement outcomes
Coordinates and collaborates with internal and external stakeholders to achieve payer reimbursement objectives