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Posted 2w ago

Sr. Healthcare Provider Contracting Analyst

@ CenCal Health
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Santa Barbara, California, United States
$121k-$181k/yrRemoteFull Time
Responsibilities:analyzing contracts, developing models, presenting findings
Requirements Summary:Bachelor's degree in a related field and 5+ years healthcare financial analysis (3+ years reimbursement/contract analysis). Advanced SQL and Microsoft Excel skills, knowledge of Medicaid/Medicare reimbursement and value-based models, strong analytical and communication skills.
Technical Tools Mentioned:SQL, Microsoft Excel
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Job Description

Central Coast Salary Range: $120,970 - $181,455 



Job Summary

The Senior Financial Analyst - Provider Contracts independently performs complex financial modeling, reimbursement rate development, and provider contract change analysis for Medicaid Managed Care & Medicare Advantage D-SNP Plan. This role utilizes advanced SQL, claims data analysis and financial modeling techniques to assess the financial impact of provider contracts including fee for service, capitation, and value based arrangements, while ensuring alignment with state regulatory requirements, quality initiatives, and organizational affordability objectives.

Serving as a subject matter expert in provider reimbursement and value based payment analytics, this position supports data driven contracting, negotiation, and provider performance strategies through close collaboration with Provider Contracting, Provider Relations, Quality, and IT/Data Analytics departments.

Key areas of responsibility include, but are not limited to: 





  1. Provider Contract Financial Analysis




  2. Rate Development Modeling




  3. Advanced SQL & Data Analysis




  4. Cross-Functional Partnership & Strategic Support




  5. Data Governance, Accuracy & Regulatory Compliance




  6. Leadership, Mentorship & Operational Support




  7. Other duties as assigned





Duties and Responsibilities

1.    Provider Contract Financial Analysis





  • Perform detailed financial impact analysis for:





    • New provider contracts




    • Contract renewals, amendments, and rate adjustments




    • Benefit changes, carve ins/outs, and escalators




    • Value based contracting arrangements, including shared savings, shared risk, quality incentives, and performance based payments






  • Analyze utilization, unit cost, PMPM, and total cost of care impacts using historical claims and encounter data.




  • Support facility, professional, and ancillary provider reimbursement structures across the Medicaid and Medicare lines of business, including capitation, fee-for-service (FFS) and value based payment models or hybrid models.





2.    Rate Development & Modeling





  • Develop provider reimbursement models including:





    • Fee for service (CPT/HCPCS, DRG, APC)




    • Case rates, per diems, and bundled payments




    • Capitation, value based payments, and alternative payment models (APMs)






  • Build scenario based financial models—covering upside and downside risk—to support contracting negotiations and leadership decisions.




  • Develop financial methodologies to support value based contract components such as incentive pools, withholds, risk corridors, benchmarks, and performance thresholds.




  • Ensure contract financial assumptions align with:





    • Medicaid state contract and value based purchasing requirements




    • CMS Medicaid Managed Care Guidance




    • Network adequacy, access, quality, and affordability standards







3.    Advanced SQL & Data Analysis





  • Use advanced SQL to:





    • Extract, transform, and analyze large Medicaid claims datasets




    • Develop custom datasets for contract modeling, reimbursement analysis, and value based performance measurement




    • Validate utilization, unit cost, trend, and attribution assumptions used in financial and VBC models






  • Analyze provider performance against cost, utilization, and quality metrics tied to value based arrangements, including calculation of earned incentives, shared savings, or losses.




  • Create reproducible, well documented SQL queries to support ongoing contract evaluations and value based reconciliations.




  • Partner with data analytics teams to ensure data integrity, consistency, and appropriate methodology for both reimbursement and VBC reporting.





4.    Cross Functional Partnership & Strategic Support





  • Partner closely with Provider Contracting to support negotiations with data backed financial insights across fee for service and value based agreements.




  • Collaborate with Provider Network, Quality and Clinical teams to align financial models, benchmarks, and performance targets for value based contracts.




  • Translate complex analytical findings into clear, actionable messages for non finance stakeholders, including summaries of value based performance, risks, and opportunities.





 

5.    Data Governance, Accuracy & Regulatory Compliance





  • Document assumptions, methodologies, benchmarks, and reconciliation logic supporting provider contract financial reviews and value based arrangements.




  • Ensure analyses comply with:





    • CMS & State Regulations




    • State specific reimbursement and value based purchasing requirements




    • Internal financial controls and audit standards






  • Support internal and external audits, contract reconciliations, and regulatory reporting related to provider reimbursement and value based payments.





6.    Leadership, Mentorship & Operational Support





  • Serve as a subject matter expert in provider contract financial analysis, reimbursement modeling, and value based payment evaluation.




  • Review and validate analyses produced by junior analysts, including value based performance calculations.




  • Contribute to standardization, automation, and process improvement initiatives for contract modeling, VBC analytics, and performance reporting.





7.    Other duties as assigned