Payer Strategy and Contracting Analyst

CareAbout

About The Position

CareAbout delivers end-to-end value-based care solutions combining hands-on service, AI-powered technology, and strategy. The Payer Strategy and Contracting department manages payer relationships and agreements for supported organizations, including fee-for-service agreements, value-based and shared savings programs, Medicare Advantage arrangements, and Medicare accountable care organization participation. The department also conducts strategic planning, contract performance tracking, and reconciliation. The analyst supports payer relations, contract and program administration, joint operating committee and governance meetings, cross-functional coordination, analysis and reporting, and special projects. The role serves as a working contact for payer representatives, coordinates information and deliverables across internal teams, maintains contract and action-item records, analyzes payment and program performance, and prepares materials for negotiations, committees, executives, and physicians. The position requires discretion with confidential contract, financial, and protected health information and familiarity with HIPAA requirements. The role is based in New York, New York. Salary is determined in part by education, experience, knowledge, skills, abilities, and location, as well as internal equity and market data. The employer is unable to provide visa sponsorship.

Requirements

Bachelor's degree in healthcare administration, business administration, public health, economics, finance, or a related field.
Two to four years of experience at a health plan, medical group, independent practice association, accountable care organization, management services organization, health system, or healthcare consulting firm in contracting, provider relations, network management, value-based care, revenue cycle, or healthcare analytics.
Working knowledge of provider reimbursement, including fee-for-service fee schedules and their relationship to the Medicare Physician Fee Schedule, CPT and HCPCS coding basics, and claims adjudication.
Familiarity with value-based payment arrangements such as shared savings, pay-for-performance, and Medicare Advantage quality and risk adjustment programs.
Proficiency in Microsoft Excel, including lookups, pivot tables, and working with large data sets, as well as Microsoft Word, PowerPoint, and Outlook.
Clear, accurate, and concise written communication, demonstrated through professional correspondence, meeting minutes, and summaries.
Strong organization and follow-through, including the ability to manage a high volume of open items across many counterparties.
Professional presence in interactions with external payer representatives, physicians, and executives.
Discretion in handling confidential contract, financial, and protected health information, and familiarity with HIPAA requirements.
Legally able to work in the United States without sponsorship.

Nice To Haves

Master's degree (MHA, MPH, or MBA).
Familiarity with the New Jersey and Florida payer landscape.
Experience with the Medicare Shared Savings Program, Medicare Advantage value-based arrangements, or commercial pay-for-performance programs.
Experience reading and summarizing contract language, including fee schedules, amendments, and program exhibits.
Experience supporting joint operating committees or other payer-provider governance meetings.
Experience with SQL, Power Query, Power BI, Domo, Snowflake, or Python for reporting and analysis.
Experience with athenahealth or another practice management system.
Residence in New Jersey or Florida with the ability to travel within both states as required.

Responsibilities

Serve as the department's primary working contact with payer provider relations, network management, contracting, and value-based care representatives on routine matters.
Initiate, document, and follow up with payers on contract questions, roster and participation issues, claims and rate discrepancies, data and report requests, program deliverables, and outstanding meeting items.
Maintain payer contacts and escalation details, draft correspondence and meeting communications for Senior Vice President review, and track open payer items with owners, status, next steps, and target dates.
Manage the Joint Operating Committee calendar, schedule meetings, confirm attendees, distribute agendas and pre-read materials, collect agenda inputs, take minutes, record decisions and action items, and track actions to completion.
Support internal governance and committee meetings with scheduling, materials, minutes, and recordkeeping.
Coordinate with clinical operations, care coordination, quality, risk adjustment and coding, revenue cycle management, credentialing, and finance.
Research internal questions about contract terms, program requirements, attribution rules, payer policies, and payment mechanics; respond on settled matters and escalate questions requiring interpretation or decisions.
Maintain a log of internal questions and answers, coordinate provider roster and participation submissions, and reconcile payer rosters against internal records.
Maintain contract inventories, including executed agreements, amendments, fee schedules, program exhibits, and key terms.
Maintain calendars of contractual deliverables and deadlines and confirm submissions and other deliverables are completed on time.
Support contract implementation by checking that negotiated rates and terms are loaded correctly and that payer participation and rosters are accurate.
Monitor payer policy updates, fee schedule notices, and program communications, and summarize operational and financial implications for the Senior Vice President.
Track performance of value-based and shared savings programs, including attribution, quality performance, incentive and shared savings payments, and reconciliation status.
Prepare fee schedule comparisons, rate positioning analyses relative to Medicare, and claims and payment variance analyses.
Build and maintain trackers, workbooks, and dashboards using Excel and the organization's business intelligence tools.
Prepare data pulls, reports, and supporting documentation for negotiations, committee meetings, and executive reviews, and verify figures, sources, and labels before distribution.
Carry assigned initiatives through completion, including acquisition and affiliation diligence, new program and contract implementations, network development and optimization, accountable care organization participation, and process improvement.
Draft memos, summaries, presentations, and status updates for executive, committee, and physician audiences.
Manage concurrent assignments with changing priorities and maintain a current project list with status and next steps.
Perform other duties as assigned.