Payer Analytics Consultant

AI overview

Drive payer reimbursement strategies through complex financial analysis and collaboration with stakeholders to improve quality healthcare while reducing costs.

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

  • 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
  • And many more

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. 

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

Join us at Central California Alliance for Health (the Alliance) is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We currently serve more than 418,000 members. To learn more about us, take a look at our Fact Sheet.


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.

Perks & Benefits Extracted with AI

  • Health Insurance: Medical, Dental and Vision Plans
  • Additional benefits available: And many more
  • Paid Time Off: Ample Paid Time Off
  • Wellness Stipend: Robust Health and Wellness Program

Who We Are Central California Alliance for Health (the Alliance) is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We currently serve more than 418,000 members. Founded in 1996, the Alliance was established to improve access to health care for lower income residents. We have pursued this mission by linking members to primary care physicians and clinics who assist in managing their care. To learn more about us, take a look at our Fact Sheet.   Our Culture 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.  Guided by our values of Improvement, Integrity, Collaboration and Equity, we strive to fulfill our vision of “Healthy people. Healthy communities.” This focus includes finding innovative solutions that lead to better health outcomes. Come join us!   Career Growth and Advancement We support career development through promotional opportunities in a growing, financially stable organization. Get on-the-job-training and gain experience in an exemplary managed care model. To further support your career journey, we offer full access to LinkedIn Learning and annual tuition reimbursement.   Support for Your Health and Wellness We believe in supporting the whole person and offer a comprehensive benefits package that includes medical, dental and vision coverage for you and your dependents. Learn more about our benefits in this comprehensive guide. In addition to 12 paid holidays per year, we provide ample paid time off. We recognize the importance of work-life balance, so we offer flexible scheduling and extra support when you need it most. To promote health and wellness, we provide reimbursements for gyms and online fitness classes. Your financial future is important to us. The Alliance contributes 10% of your salary to a defined contribution 401(a) plan after one year of employment. We also provide you with an opportunity to save voluntarily via our 457 retirement savings plan.   Equal Opportunity At the Alliance, one of our values is that of Equity. We consciously work toward eliminating disparity through inclusion and justice. With that, it's our belief that all people are entitled to equal employment opportunities, and the Alliance is committed to compliance with all applicable laws providing equal employment opportunities. The Alliance is proud to be an equal employment opportunity employer where we cultivate belonging, nurture inclusion and value diversity to create collaborative and innovative teams. We assure equal treatment in the administration of employment decisions including recruitment, selection, hiring and compensation and applicants will receive consideration for employment on the basis of merit, experience and other applicable work-related criteria, without regard to race, color, religion, religious creed, national origin, ancestry, citizenship, age, physical disability, mental disability, legally protected medical condition, genetic characteristics, genetic information, marital status, domestic partner status, family care status, sex (including pregnancy, childbirth breastfeeding and/or related medical conditions), sexual orientation, gender, gender identify, gender expression, political activities or affiliations, military or veteran status or any other characteristic protected by federal, state or local laws. We encourage all people from all backgrounds to apply. Come join us and find out the positive impact you can have in helping us carry out our mission. The Alliance is committed to the full inclusion of all qualified individuals. As part of this commitment, we will ensure that persons with disabilities are provided with reasonable accommodation. If reasonable accommodation is needed to participate in the job application or interview process, please contact the Talent Acquisition team at [email protected] or call the Alliance at 831-430-5500.   Get to Know Us Follow us on LinkedIn to stay up-to-date with new opportunities and to learn more about what it’s like to be a member of our team. To learn more about our culture and what our current and former employees say, check out our Glassdoor page. See how we connect with our members by visiting our Facebook page. Learn about our mission, vision and values.     Frequently Asked Questions Can the Alliance sponsor my visa? At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States at the time of application and hire on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship. As required by federal law, all newly hired employees must be able to provide evidence of eligibility to work in the United States. Acceptable forms of identification can be found on the www.uscis.gov website. What happens after I send in my application? We look at each and every resume and application that we receive. A Recruiter will review your resume and qualifications against the position description for the job that you applied to. We'll get you updates as soon as we can about the status of your application. Once we have your resume on file, we'll also keep you in mind for other positions and may reach out with other opportunities that you might be interested in. What are those temporary jobs that you have listed? Sometimes we have temporary (temp) positions that we hire in addition to our regular positions. The temp positions typically have a set start and end date but can change based on the business need. Usually the temp positions are covering an employee's leave of absence, or are working on a special project. We have all of our temp employees get signed up with a local temporary staffing agency while they are on an assignment with us. The temp positions can be a great way to check out the Alliance and learn more about the work that we do.    

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