Healthcare Analytics – Payor/Provider Finance Data and AI, Managed Care Contracting & Optimization

Role Overview

• The Healthcare Finance Data and AI team translates healthcare data into measurable healthcare financial performance
• Learn and interpret payer contracts (fee schedules, DRG/APC, per diem, percent-of-charge, case rates, carveouts, stoploss/outlier, multiple procedure reductions, modifiers, bundling/packaging rules, lesser-of logic, escalators, effective dates, term/renewal, amendments)
• Translate contract terms into machine-readable logic and configure/model those terms in our existing pricing/adjudication tools
• Validate modeled results by reconciling remittance advice (835/ERA) and historical payments; investigate and resolve discrepancies with root cause analysis
• Maintain a controlled library of contract models (versioning, effective/expiry dates, audit trail, documentation of assumptions)
• Build/optimize ETL/ELT pipelines to ingest fee schedules and contract artifacts; implement QA/validation checks
• Use advanced SQL (window functions, CTEs, stored procedures, query tuning) to automate contract lookups, grouper logic, case mix normalization, and variance analytics
• Use Python for parsing artifacts, applying calculation engines, regression/variance checks, and generating repeatable validation reports
• Develop Power BI/Tableau dashboards for contract performance
• Own analytics workstreams; present findings that connect contract mechanics to RCM KPIs
• Work with Managed Care/Finance, Revenue Integrity/CDM, PFS, and IT/Data teams to align interpretation, data sources, and operationalization
• Support pursuits showcasing our contract modeling capabilities and automation

Requirements

• Bachelor's degree is required
• Minimum THREE (3) years of experience in healthcare analytics, consulting, or adjacent healthcare services with measurable data driven outcomes
• Experience building production-grade ETL/ELT processes and implementing data quality frameworks
• Proficiency with BI/visualization tools (Power BI or Tableau) and strong Excel skills
• Excellent communication—able to translate technical and contractual details into concise, executive-ready insights
• Detail oriented, self-directed, collaborative teammate comfortable leading workstreams

Tech Stack

• ETL
• Python
• SQL
• Tableau

Benefits

• Medical, Rx, Dental & Vision Insurance
• Personal and Family Sick Time & Company Paid Holidays
• Position may be eligible for a discretionary variable incentive bonus
• Parental Leave and Adoption Assistance
• 401(k) Retirement Plan
• Basic Life & Supplemental Life
• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
• Short-Term & Long-Term Disability
• Student Loan PayDown
• Tuition Reimbursement, Personal Development & Learning Opportunities
• Skills Development & Certifications
• Employee Referral Program
• Corporate Sponsored Events & Community Outreach
• Emergency Back-Up Childcare Program
• Mobility Stipend