Provider Contracting Analyst II
Core
Develop, validate, and optimize provider reimbursement strategies through data analysis, financial modeling, and AI-enabled tools to support contracting decisions.
Role type
Provider Contracting Analyst
Builds
Provider reimbursement models, contract repricing analyses, and actionable insights for rate development
Domain
Healthcare / Reimbursement & Contracting
Deliverable
production ML models | dashboards & analysis
Required skills
Healthcare reimbursement methodologies, Medicare/Medicaid/commercial payment models, CPT/HCPCS coding, DRGs, APCs, SQL, Python, business intelligence tools, data analytics automation, AI-assisted tools
Preferred skills
Analytics automation, AI-assisted tools
Technologies
SQL, Python, Power BI, Tableau
Responsibilities
Develop and maintain provider reimbursement models across multiple payment structures; Perform contract repricing analyses using claims data; Analyze key financial metrics to identify cost drivers; Support benchmarking of provider reimbursement rates; Evaluate pricing approaches for unlisted codes; Utilize SQL, Python, and BI tools to analyze complex healthcare datasets; Leverage automation and AI tools to improve data processing efficiency; Apply advanced analytical techniques to identify anomalies and cost containment opportunities; Perform scenario modeling for alternative reimbursement structures; Partner with contracting, finance, and operational teams; Support implementation of reimbursement logic within claims processing systems
Seniority
Mid-level, hands-on IC