Lead Payer Analytics Consultant

We have an opportunity to join the Alliance as a Lead Payer Analytics Consultant in the Payment Strategy Department. 

There are two positions that can be filled remotely for those living in California.

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Provider Payment Strategy Director, this position:

• Functions as a strategic consultant to Alliance executive leadership in the areas of complex managed care payer financial modeling and statistical analysis to evaluate the feasibility of payer reimbursement methodologies
• Advises Alliance executive leadership on organizational decision making through the performance of   complex financial analysis to support successful payer reimbursement outcomes
• Acts as subject matter expert and collaborates with internal and external stakeholders to achieve payer reimbursement objectives
• Acts as a subject matter expert and lead to subordinate staff

ABOUT THE TEAM

The Payment Strategy department ensures the Alliance's payments to our network are adequate to our revenue. We also work to advance our payment methodology in order to achieve the best quality healthcare while reducing costs. 

THE IDEAL CANDIDATE 

• An experienced analytical and collaborative lead, with direct experience with complex medical payor modeling
• Technically strong, with skill in provider reimbursement modeling, payment structure design and reimbursement strategies
• A collaborative and professional communication style, building productive relationships supporting multiple stakeholders
• Experience with Medicare and/or Medi-Cal (Medicaid) a plus

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirements click here.

• Knowledge of:
• 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
• Healthcare financial statements and accounting principles
• Methods and techniques of developing and delivering data management strategies that support contract analysis, trend management, budgeting, forecasting, strategic planning, and healthcare operations 
• National standards for fee-for-service and value-based provider reimbursement methodologies, including risk-sharing models
• Ability to:
  • National standards for fee-for-service and value-based provider reimbursement methodologies, including risk-sharing models
  • Demonstrate strong analytical, critical thinking, and research skills, identify and troubleshoot issues, identify alternative solutions, and make recommendations for action
  • Be a technical resource, provide guidance related to area of assignment, and explain related regulations, processes, and programs
  • Lead, train, mentor and motivate staff, and promote an atmosphere of teamwork and cooperation 
  • Produce organized, accurate, and detail-oriented work in a fast-paced environment and under the pressure of deadlines
• Education and Experience:
  • Bachelor’s degree in Business Administration, Accounting, Finance, Healthcare, or a related field 
  • A minimum of eight 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.

The full compensation range for this position is listed by location below. 

The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).

Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area

Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area

OUR BENEFITS 

Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance.

• Medical, Dental and Vision Plans
• Ample 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

ABOUT US

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. 

Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet.

The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer

At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.