[Remote] Sr. Healthcare Provider Contracting Analyst

Note: The job is a remote job and is open to candidates in USA. CenCal Health is seeking a Senior Healthcare Provider Contracting Analyst to perform complex financial modeling and reimbursement rate development for Medicaid Managed Care & Medicare Advantage D-SNP Plan. This role involves analyzing provider contracts and collaborating with various departments to support data-driven contracting and negotiation strategies.ResponsibilitiesPerform detailed financial impact analysis for:New provider contractsContract renewals, amendments, and rate adjustmentsBenefit changes, carve ins/outs, and escalatorsValue based contracting arrangements, including shared savings, shared risk, quality incentives, and performance based paymentsAnalyze utilization, unit cost, PMPM, and total cost of care impacts using historical claims and encounter dataSupport 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 modelsDevelop provider reimbursement models including:Fee for service (CPT/HCPCS, DRG, APC)Case rates, per diems, and bundled paymentsCapitation, value based payments, and alternative payment models (APMs)Build scenario based financial models—covering upside and downside risk—to support contracting negotiations and leadership decisionsDevelop financial methodologies to support value based contract components such as incentive pools, withholds, risk corridors, benchmarks, and performance thresholdsEnsure contract financial assumptions align with:Medicaid state contract and value based purchasing requirementsCMS Medicaid Managed Care GuidanceNetwork adequacy, access, quality, and affordability standardsUse advanced SQL to:Extract, transform, and analyze large Medicaid claims datasetsDevelop custom datasets for contract modeling, reimbursement analysis, and value based performance measurementValidate utilization, unit cost, trend, and attribution assumptions used in financial and VBC modelsAnalyze provider performance against cost, utilization, and quality metrics tied to value based arrangements, including calculation of earned incentives, shared savings, or lossesCreate reproducible, well documented SQL queries to support ongoing contract evaluations and value based reconciliationsPartner with data analytics teams to ensure data integrity, consistency, and appropriate methodology for both reimbursement and VBC reportingPartner closely with Provider Contracting to support negotiations with data backed financial insights across fee for service and value based agreementsCollaborate with Provider Network, Quality and Clinical teams to align financial models, benchmarks, and performance targets for value based contractsTranslate complex analytical findings into clear, actionable messages for non finance stakeholders, including summaries of value based performance, risks, and opportunitiesDocument assumptions, methodologies, benchmarks, and reconciliation logic supporting provider contract financial reviews and value based arrangementsEnsure analyses comply with:CMS & State RegulationsState specific reimbursement and value based purchasing requirementsInternal financial controls and audit standardsSupport internal and external audits, contract reconciliations, and regulatory reporting related to provider reimbursement and value based paymentsServe as a subject matter expert in provider contract financial analysis, reimbursement modeling, and value based payment evaluationReview and validate analyses produced by junior analysts, including value based performance calculationsContribute to standardization, automation, and process improvement initiatives for contract modeling, VBC analytics, and performance reportingOther duties as assignedSkillsStrong analytical and quantitative problem solving skillsAdvanced SQL querying and data analysis skills, including the ability to extract, manipulate, validate, and analyze large healthcare datasetsStrong proficiency in Microsoft Excel, including pivot tables, advanced formulas, and modeling techniquesFinancial evaluation of value based care and alternative payment modelsClear written and verbal communication skills with the ability to present complex financial information to technical and non-technical audiencesSound financial judgment, risk assessment, and attention to detailSkilled in Collaboration and relationship management across cross-functional departments including finance, contracting, quality, and clinical teamsKnowledge of healthcare finance, provider reimbursement methodologies, and managed care operations, including Medicaid and Medicare Advantage/D-SNP programsKnowledge of provider contracting structures, including fee-for-service, capitation, shared savings, and value-based payment arrangementsKnowledge of healthcare claims processing, encounter data, and financial reporting principlesAdvanced analytical and financial modeling skills, with the ability to interpret complex datasets and identify financial trends and impactsAbility to independently perform complex financial analysis with a high degree of accuracy and attention to detailAbility to translate large volumes of financial data into actionable business insights and strategic recommendationsAbility to maintain confidentiality and exercise sound financial judgement in handling sensitive financial and provider informationAbility to work effectively in a fast-paced, collaborative environment while meeting deadlinesStrong understanding of healthcare claims data, reimbursement methodologies, value based payment models, and unit cost analysisAdvanced Excel skills (financial modeling, complex formulas, scenario analysis)Ability to independently manage multiple complex contract analyses in a deadline driven environmentBachelor's degree in Finance, Accounting, Economics, Healthcare Administration, or related fieldMinimum of five (5) years of progressively responsible healthcare financial analysis experience, preferably within healthcare, managed care, provider contracting, or health plan operationsMinimum of three (3) years of experience performing healthcare reimbursement analysis, provider payment modeling, or contract financial analysisExperience supporting a Medicaid Managed Care Plan or Medicaid line of businessAdvanced experience using SQL, including: complex joins, subqueries, aggregations, and performance conscious query designCompany OverviewCenCal Health focuses on the improvement of the well-being of the communities with various social services and health plans. It was founded in 1983, and is headquartered in Santa Barbara, California, USA, with a workforce of 201-500 employees. Its website is https://www.cencalhealth.org.