Payer and Provider Contract Performance Analyst

Community Care Physicians•Town of Colonie, NY

1d•$75,000 - $85,000•Onsite

About The Position

The Payer and Provider Contract Performance Analyst will be part of a multidisciplinary team focused on detailed payer contracting and payment analysis. This role is responsible for identifying operational issues, delivering actionable insights, and supporting strategic decisions and contract negotiations. The ideal candidate will bring a strong background in insurance payer operations and value-based care programs, along with a deep understanding of payer-provider dynamics, healthcare claims data, and value-based care incentives. Proven experience in analyzing complex contracts and payment models across various insurance programs is essential.

Requirements

Bachelor’s degree in healthcare administration, Business, Finance, business analytics, or related field.
3–5+ years of experience in healthcare analytics, payer contracting, or healthcare finance, with direct experience in insurance payer operations.
Proficiency in claims analysis, payment reconciliation, and financial modeling.
Advanced Excel skills and experience with data visualization and reporting tools (e.g. Tableau, Power BI, or similar).
Strong analytical thinking with the ability to translate complex data into clear, actionable insights.
Strong knowledge of value-based care models, including ACOs, shared savings, pay-for-performance, capitation, and bundled payments.
Excellent communication skills, with the ability to present findings to both technical and non-technical stakeholders.

Nice To Haves

Master’s degree preferred.
Experience working within a health plan, managed care organization, or provider group with value-based payment arrangements preferred.
Familiarity with CMS models (e.g., MSSP, Direct Contracting, ACO REACH) and commercial value-based contracts preferred.

Responsibilities

Evaluate payment and claims data to identify trends, discrepancies, or operational concerns related to contract adherence and financial performance.
Collaborate with cross-functional teams including contracting, finance, data analytics, operations, and clinical leadership to ensure alignment on payment models and strategic goals.
Generate and present insightful reports and dashboards that provide visibility into contract performance, incentive metrics, and revenue optimization opportunities.
Support contract negotiation efforts by providing data-driven insights and financial modeling to guide payer strategy.
Identify and troubleshoot payment processing issues, working with payers and internal stakeholders to resolve underpayments or inconsistencies.
Analyze healthcare payer contracts with an emphasis on value-based arrangements, shared savings, risk models, and performance incentives.
Monitor and assess the effectiveness of value-based care programs, providing recommendations to enhance quality outcomes and financial performance.
Stay current on payer trends, reimbursement changes, and regulatory shifts that may impact value-based care and payer contracts.