Talent.com
Payer Analytics Consultant
Payer Analytics ConsultantCentral California Alliance for Health • Scotts Valley, CA, United States
Payer Analytics Consultant

Payer Analytics Consultant

Central California Alliance for Health • Scotts Valley, CA, United States
job_description.job_card.variable_days_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.full_time
  • serp_jobs.job_card.part_time
job_description.job_card.job_description

We have an opportunity to join the Alliance as a Payer Analytics Consultant in the Payment Strategy Department. There are two positions that can be filled as a Payer Analytics Consultant or Senior Payer Analytics Consultant level.

This position can be filled remotely for those living in California.

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Payment Strategy Director, this position :

  • 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

ABOUT THE TEAM

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.

THE IDEAL CANDIDATE

  • 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.
  • WHAT YOU'LL NEED TO BE SUCCESSFUL

    To read the full position description and list of requirements, click here .

  • Knowledge of :
  • Windows based PC systems and Microsoft Word, Outlook, PowerPoint, Access, Visual Basic, and Excel (including pivot tables), and database systems
  • Methods and techniques of financial modeling and analysis
  • Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers
  • Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider types
  • National standards for fee-for-service and value-based provider reimbursement methodologies, including risk-sharing models
  • 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
  • Demonstrate strong analytical, critical thinking, and research skills, identify and troubleshoot issues, identify alternative solutions, and make recommendations for action
  • Translate data into understandable information and deliver solutions that improve business processes
  • Act as a technical resource, provide guidance related to area of assignment, and explain related regulations, processes, and programs
  • Interpret and apply rules, regulations, policies, procedures, and guides
  • Work collaboratively with individuals at all levels of the organization while supporting multiple stakeholders
  • Education and Experience :

  • 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
  • OTHER INFORMATION

  • We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
  • While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
  • In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.
  • The full compensation range for this position is listed by location below.

    The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).

    Typical areas in Zone 1 : Bay Area, Sacramento, Los Angeles area, San Diego area

    Typical areas in Zone 2 : Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area

    Zone 1 (Monterey, San Benito and Santa Cruz)

    $97,920 — $156,686 USD

    Zone 2 (Mariposa and Merced)

    $89,108 — $142,584 USD

    OUR BENEFITS

    Available for all regular Alliance employees working more than 30 hours per week.Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance.

  • Medical, Dental and Vision Plans
  • Ample Paid Time Off
  • 12 Paid Holidays per year
  • 401(a) Retirement Plan
  • 457 Deferred Compensation Plan
  • Robust Health and Wellness Program
  • Onsite EV Charging Stations
  • ABOUT US

    We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

    Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet .

    The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer

    At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

    serp_jobs.job_alerts.create_a_job

    Consultant • Scotts Valley, CA, United States

    Job_description.internal_linking.related_jobs
    Payroll Analyst

    Payroll Analyst

    Hoxton Circle • Seaside, CA, US
    serp_jobs.job_card.full_time
    Hoxton Circle has partnered with a client in the Watsonville-Castroville area to add a seasons Payroll / AP Coordinator for the team to cover a medical leave. The role is contract temporary only and c...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Finance Governance Lead

    Finance Governance Lead

    OKX • San Jose, CA, US
    serp_jobs.job_card.full_time
    At OKX, we believe that the future will be reshaped by crypto, and ultimately contribute to every individual's freedom.OKX is a leading crypto exchange, and the developer of OKX Wallet, giving mill...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_hours • serp_jobs.job_card.promoted • serp_jobs.job_card.new
    Data & Analytics Leader

    Data & Analytics Leader

    Jade Global • San Jose, CA, US
    serp_jobs.job_card.full_time
    Please find below the details of the Data & Analytics Leader opportunity at Jade Global.Kindly let me know if you would be interested in pursuing this role. Job Title : Data & Analytics Leader Locati...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Fixed Assets Consultant -Palo Alto, CA

    Fixed Assets Consultant -Palo Alto, CA

    Staffing • Palo Alto, CA, US
    serp_jobs.job_card.full_time
    Fixed Assets Accounting Consultant.Planned start date : December 15, 2017 Days required : 2 months+ Remote : Partial Location : Palo Alto, CA No H1B Project Description : Senior Technical S4 Architect w...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Workday Technical Consultant (Reporting & Data)

    Workday Technical Consultant (Reporting & Data)

    Inherent Technologies • San Jose, CA, United States
    serp_jobs.job_card.full_time
    serp_jobs.filters_job_card.quick_apply
    Position : Workday Technical Consultant (Reporting & Data) Location : Fremont, CA •Day 1 Onsite ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days
    AML Transaction Monitoring FIU Manager

    AML Transaction Monitoring FIU Manager

    Meta Platforms • Menlo Park, CA, US
    serp_jobs.job_card.full_time
    AML Transaction Monitoring FIU Manager.As a leader on the Meta FinTech Compliance Transaction Monitoring Financial Intelligence Unit (FIU) team, you will be managing and supervising a team conducti...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Senior Analyst, Process Analytics Reporting & Technology (PART)

    Senior Analyst, Process Analytics Reporting & Technology (PART)

    Apple • Cupertino, CA, US
    serp_jobs.job_card.full_time
    Senior Analyst, Process Analytics Reporting & Technology (PART).Imagine what you could do here.The people at Apple don't just create products they create the kind of wonder that's revolutionized e...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Program Manager I, Data Analytics, Core

    Program Manager I, Data Analytics, Core

    Google • Sunnyvale, CA, US
    serp_jobs.job_card.full_time
    Program Manager I, Data Analytics, Core.A problem isn't truly solved until it's solved for all.That's why Googlers build products that help create opportunities for everyone, whether down the stree...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Director, Payer Relations - Shockwave

    Director, Payer Relations - Shockwave

    J&J Family of Companies • Santa Clara, CA, US
    serp_jobs.job_card.full_time
    Director, Payer Relations - Shockwave.Johnson and Johnson is currently seeking the best talent for a Director, Payer Relations - Shockwave within the Johnson & Johnson MedTech organization.This is ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Oracle EBS Financial Functional Consultant

    Oracle EBS Financial Functional Consultant

    Advantra Consulting Group • Santa Clara, CA, United States
    serp_jobs.job_card.full_time
    serp_jobs.filters_job_card.quick_apply
    Job Title : Oracle EBS Financial Functional Consultant Location : ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days
    Agent Deployment Architect, Payor Integrations

    Agent Deployment Architect, Payor Integrations

    Hippocratic AI • Palo Alto, CA, United States
    serp_jobs.job_card.full_time
    Agent Deployment Architect, Payor Integrations.Agent Deployment Architect, Payor Integrations.Agent Deployment Architect, Payor Integrations. Be among the first 25 applicants.Agent Deployment Archit...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    PayPal Fraud Analyst

    PayPal Fraud Analyst

    TradeJobsWorkforce • 95161 San Jose, CA, US
    serp_jobs.job_card.full_time
    Make an impact in the role of PayPal Fraud Analyst to perform daily responsibilities with dedication.Stay adaptable in a dynamic, fast-paced environment. Work with your team to maintain efficiency a...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Treasury Analyst

    Treasury Analyst

    Apple • Cupertino, CA, US
    serp_jobs.job_card.full_time
    Imagine what you could do here.At Apple, new ideas have a way of becoming great products, services, and customer experiences very quickly. Bring passion and dedication to your job and there's no tel...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Data Analytics Manager

    Data Analytics Manager

    Salinas Valley Health • Salinas, CA, US
    serp_jobs.job_card.full_time
    It's fun to work in a company where people truly BELIEVE in what they're doing!.We're committed to bringing passion and customer focus to the business. Department : Quality Management.The Data Analyt...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Future Opportunities at EarnIn

    Future Opportunities at EarnIn

    EarnIn • Mountain View, CA, US
    serp_jobs.job_card.full_time
    Software Engineer (EarnIn Payroll).Engineering Manager, Machine Learning.Senior Machine Learning Engineer.Senior Machine Learning Engineer (Algo). Senior Machine Learning Engineer : ML Platforms.Seni...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    SAP Procure to Pay

    SAP Procure to Pay

    Tech Digital • San Jose, CA, US
    serp_jobs.job_card.full_time
    SAP Procure To Pay (Direct & Indirect) Business Analyst (Coupa & SAP).SAP Procure to Pay (Direct & Indirect) Business Analyst with a strong techno-functional background in Coupa.This role is essent...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Director, FinTech - Tax Product Lead

    Director, FinTech - Tax Product Lead

    PayPal • San Jose, CA, United States
    serp_jobs.job_card.full_time
    Director, FinTech - Tax Product Lead.We are seeking a Director, Finance Technology – Tax Lead to drive strategy, design, and execution of tax technology across PayPal’s global finance systems.This ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Sr. Analyst, AppleCare Product Finance and Pricing

    Sr. Analyst, AppleCare Product Finance and Pricing

    Apple • Sunnyvale, CA, US
    serp_jobs.job_card.full_time
    Analyst, AppleCare Product Finance and Pricing.Imagine what you could do here.At Apple, new ideas have a way of becoming great products, services, and customer experiences very quickly.Bring passio...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Technology Analyst Relations Consultant

    Technology Analyst Relations Consultant

    US Tech Solutions • Sunnyvale, CA, US
    serp_jobs.job_card.full_time
    Duration : 8 Months Location : Sunnyvale, CA (onsite in a hybrid model).About The Team : The Client's Analyst Relations (AR) team is a small, high-impact group within the Product Marketing organizatio...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Director of Customer Success - Payor

    Director of Customer Success - Payor

    Hippocratic AI • Palo Alto, CA, US
    serp_jobs.job_card.full_time
    Hippocratic AI is seeking a Director of Customer Success to lead our most strategic payor partnerships and a high-performing team of Customer Success Executives. In this role, you'll combine executi...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted