Central California Alliance for Health - Payer Analytics Consultant (Defined Term)

• 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. • 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 • 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.