Director - Payor Contracting Analytics

Responsibilities

• Establish and lead the system wide analytical strategy supporting payor contracting activities.
• Align analytical priorities with contracting timelines, financial planning cycles, and executive decision needs.
• Serve as the primary authority on analytical rigor, methodology selection, and analytical framing for payor contract evaluation.
• Direct the development, maintenance, and validation of reimbursement models across fee for service, DRG, case rate, per diem, capitation, and value based payment arrangements.
• Build forward looking financial forecasts that quantify expected revenue, margin, and risk exposure under varying contract scenarios.
• Support negotiation preparation through scenario modeling, sensitivity analysis, and downside risk assessment.
• Lead post implementation monitoring of payor contract performance.
• Analyze variance between expected and actual performance and identify drivers of under or over performance.
• Surface actionable insights to support corrective actions, renegotiation strategy, or operational adjustments.
• Oversee analysis of claims, encounter, reimbursement, and financial data related to managed care contracts.
• Identify trends, patterns, and emerging risks or opportunities across commercial, Medicare Advantage, and Medicaid payors.
• Translate complex data into concise, decision ready insights for executive and governance audiences.
• Establish and maintain standard modeling assumptions, documentation practices, and analytical quality controls.
• Ensure consistency, transparency, and auditability of all contract analytics.
• Continuously evaluate and improve analytical approaches as reimbursement models and payer behaviors evolve.
• Partner closely with Payor Contracting leadership, Finance, Revenue Cycle, Population Health, and Enterprise Analytics.
• Support executive discussions, governance reviews, and negotiation planning forums with clear, well-structured analysis.
• Act as a trusted analytical advisor to senior leaders on managed care financial performance and risk.
• Design and steward the future state payor contracting analytics operating model.
• Evaluate and incorporate advanced analytics and AI enabled capabilities to improve efficiency, insight generation, and analytical reach while maintaining governance and accountability.

Requirements

• Bachelor's degree in Finance, Health Administration, Economics, Analytics, Statistics, or a related field.
• Masters in MBA, MHA, MPH, MS, or related discipline preferred.
• At least 5 years of direct experience supporting or leading payor contracting analytics and negotiation preparation.
• At least 10 years of progressive experience in healthcare analytics, managed care, finance, or revenue related functions.
• Prior experience within a large health system, multi hospital provider organization, or managed care environment strongly preferred.