Senior Healthcare Analyst
About The Position
The Senior Healthcare Analyst serves as a strategic partner supporting health plan operations through analytics, reimbursement expertise, and cross-functional collaboration. This role transforms complex healthcare data into actionable business insights, supports payment integrity and provider reimbursement initiatives, develops scalable reporting solutions, and partners with operational leaders to improve quality, efficiency, and financial performance. The ideal candidate combines strong analytical skills with deep knowledge of healthcare operations, reimbursement methodologies, provider contracting, and health insurance business processes.
Requirements
- Bachelor's degree or equivalent experience in related field
- 5+ years of work experience beyond degree
- 3+ years of work experience in provider reimbursement, provider network management, or provider contracting
- 3+ years of experience with healthcare claims and payment operations
- Knowledge of facility and professional reimbursement methodologies
- Advanced SQL skills
- Advanced Microsoft Excel skills
- Strong analytical, organizational, and problem-solving skills
Nice To Haves
- Familiarity with CMS payment rules, Medicare Physician Fee Schedule (MPFS), Hospital Outpatient Prospective Payment System (OPPS), Inpatient Prospective Payment System (IPPS), and Ambulatory Surgery Center (ASC) payment methodologies.
- Experience with Power BI, QlikSense, or similar business intelligence tool
- Experience working with provider contracts and reimbursement structures, including payment methodologies for both facility and professional providers.
- Strong understanding of how contractual reimbursement terms impact claims adjudication and payment accuracy.
Responsibilities
- Analyze medical, pharmacy, claims, provider, and operational datasets to identify trends, risks, and improvement opportunities.
- Develop executive dashboards, scorecards, and KPI reporting.
- Deliver financial analyses and reporting (recurring and adhoc) that support provider contracting, reimbursement, and actuarial strategies.
- Support efforts to improve data quality, transparency, and accessibility of provider payment, contract, and claims data.
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
Senior
