Director, Provider Network & Analytics

About the role

Avalon Healthcare Solutions is the nation’s leader in diagnostic intelligence, uniquely focused on transforming the role of diagnostic testing across the healthcare ecosystem. Our proprietary Diagnostic Insights Platform delivers evidence-based policies, curated lab networks, and real-time analytics that simplify complex diagnostics, accelerate innovation adoption, and optimize diagnostic investments.

Serving over 30 health plans and 100 million members nationwide, Avalon partners with payers and providers to ensure diagnostic testing is performed appropriately, efficiently, and at the right time. Our flexible solutions span routine and genetic testing management, automated adherence, and end-to-end diagnostics support—driving measurable value, reduced waste, and improved clinical outcomes.

With unmatched scientific rigor, deep clinical expertise, and a performance-based model, Avalon is redefining how diagnostics power personalized care and healthcare value. You will be part of a team that shapes a new market and business. Most importantly, you will help Avalon to achieve its mission and improve clinical outcomes and health care affordability for the people we serve.

For more information about Avalon, please visit www.avalonhcs.com.

Avalon Healthcare Solutions is an Equal Opportunity Employer - Vet/Disability.

Essential Functions and Responsibilities

Lead and oversee complex healthcare analytics initiatives to drive strategic planning, operational performance, and favorable financial outcomes aligned with company objectives.

Apply advanced analytical and problem-solving skills to large, complex healthcare datasets, identifying trends and opportunities that inform enterprise decisions.

Partner with senior and executive leadership as a trusted analytics advisor, supporting both internal decision-making and client engagements, clearly communicating insights, risks, and recommendations.

Develop and deliver executive-level presentations, dashboards, and strategic summaries.

Utilize advanced Microsoft Excel skills (including complex formulas, pivot tables, financial modeling, and data analysis) to support contracting, pricing, and reimbursement analytics.

Interpret and analyze healthcare utilization, reimbursement, and financial data using CPT coding knowledge, particularly as it relates to laboratory and payer contracts.

Support analytics related to healthcare contracting, including pricing analysis, utilization trends, performance monitoring, and margin optimization.

Collaborate cross-functionally with finance, contracting, clinical, and operational teams to ensure data-driven decision-making across the organization.

Establish best practices for coding and pricing governance, and data quality.

Minimum Qualifications

10+ years of progressive experience in healthcare analytics, provider network management, healthcare contracting, reimbursement analysis, or related healthcare business functions.

Experience driving strategic initiatives, leading cross-functional teams, and engaging executive stakeholders.

Demonstrated advanced analytical and problem-solving capabilities in evaluating healthcare coding, pricing, reimbursement, and claims data to support strategic business decisions.

Expert-level proficiency in Microsoft Excel, including financial modeling, data manipulation, and advanced analytical techniques.

Strong working knowledge of healthcare claims data, reimbursement analysis, and CPT/HCPCS coding, including the application of coding methodologies to healthcare analytics, reimbursement optimization, pricing strategies, and provider contracting.

Exceptional communication and presentation skills, with the ability to effectively influence senior leaders and executive stakeholders through clear, concise, and data-driven insights.

Exceptional written and verbal communication skills, with experience producing executive-level materials and presentations.

Proven ability to synthesize and translate complex technical and analytical information into strategic, actionable recommendations for executive leadership and key stakeholders.

Demonstrated success leading large-scale analytics initiatives and influencing senior leaders and executive stakeholders to achieve organizational objectives.

Preferred Qualifications

Experience supporting healthcare contracting initiatives, particularly involving clinical laboratories, health plans, provider networks, and value-based care arrangements.

Strong understanding of healthcare reimbursement methodologies, payer dynamics, contract structures, and performance analytics.

Demonstrated experience supporting enterprise-wide, cross-functional healthcare analytics programs involving multiple stakeholders and business units.