Payer Analytics Consultant (Defined Term)

About the role

The Payer Analytics Consultant (Defined Term) position is designated by the Alliance and is a position of limited duration. This role is a fully benefited position that can be filled within any of the Alliance service areas or remotely within the Pacific, Mountain, and Central time zones.

Responsibilities

• Designs and validates managed care payer models and performs moderately complex analysis to evaluate the feasibility of payer reimbursement methodologies
• Conducts moderately complex financial analysis to support successful payer reimbursement outcomes
• Collaborates with internal and external stakeholders to achieve payer reimbursement objectives

Requirements

• 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
• Education and Experience:
• 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)

Qualifications

• 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

Skills

• Technical proficiency in Windows based PC systems and Microsoft Office Suite
• Financial modeling and analysis expertise
• Provider reimbursement methodologies knowledge
• Data interpretation and trend analysis skills
• Strong communication and collaboration abilities
• Ability to work independently and as part of a team

Benefits

• Medical, Dental, and Vision Plans
• Ambient Paid Time Off
• 12 Paid Holidays per year
• 401(a) Retirement Plan
• 457 Deferred Compensation Plan
• RoBust Health and Wellness Program
• Onsite EV Charging Stations

Pay

Zone 1 Pay Range: $125,000 - $140,000
Zone 2 Pay Range: $118,000 - $132,000

Schedule

The position is a full-time role, with the possibility of remote work within the specified time zones.