Provider Financial Analyst III - Provider Reimbursement
About The Position
Medica is a nonprofit health plan serving over a million members across several states. The Provider Financial Analyst III role supports and validates provider contracting and unit cost management through financial and network pricing modeling, analysis, and reporting. This position conducts unit cost and contract valuation analysis to support network contracting negotiations and unit cost management strategies. The role is responsible for analyzing provider reimbursement, new methodology impact, and financial trends to support organizational goals and optimize provider network performance. It partners with Finance, Provider Contracting, Network Management, and Operations teams to evaluate financial impacts of provider agreements, identify cost-saving opportunities, and provide actionable insights through data analysis and reporting.
Requirements
- Bachelor's degree or equivalent experience in related field.
- 5 years of work experience beyond degree.
- Experience with SQL, Power BI, Tableau, SAS, or other analytical tools.
- Healthcare Industry experience.
Nice To Haves
- Experience analyzing healthcare claims, provider contracts, reimbursement methodologies, or medical cost data.
- Familiarity with value-based care models and alternative payment methodologies.
- Advanced proficiency in Microsoft Excel, including pivot tables, complex formulas, and financial modeling.
- Experience working with large datasets and data visualization/reporting tools.
- Strong analytical, problem-solving, and critical-thinking skills.
- Excellent verbal and written communication skills.
- Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
Responsibilities
- Analyze provider reimbursement data, medical expense trends, and financial performance metrics.
- Develop, maintain, and enhance financial models to evaluate provider contracts and payment methodologies.
- Prepare monthly, quarterly, and annual financial reports related to provider spending and network performance.
- Monitor key performance indicators (KPIs) and identify trends, risks, and opportunities for improvement.
- Perform variance analysis and explain financial results to leadership and business partners.
- Evaluate financial impacts of proposed provider contracts, amendments, and reimbursement changes.
- Model methodology changes to monitor organizational impact.
- Collaborate with Network Management teams to ensure compliance with organizational objectives.
- Extract, validate, and analyze large datasets from claims, provider, and financial systems.
- Utilize analytical tools to identify utilization patterns, cost drivers, and reimbursement trends.
- Develop dashboards and reporting solutions to improve visibility into provider financial performance.
- Ensure data accuracy and integrity across analyses and reporting.
- Collaborate with Finance, Actuarial, Medical Management, Network Operations, and Compliance teams.
- Present findings and recommendations to management and stakeholders.
- Support budgeting, forecasting, and strategic planning activities.
- Participate in special projects, audits, and financial initiatives as needed.
Benefits
- competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
