Sr. Healthcare Provider Contracting Analyst
Listed on 2026-06-19
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Finance & Banking
Senior Financial Analyst – Provider Contracts
Location:
Main Office – Santa Barbara, CA 93110
Position Type:
Full Time
Salary Range: $120,970 – $181,455 per year
Job Category:
Financial Analytics (Central Coast)
The Senior Financial Analyst – Provider Contracts independently performs complex financial modeling, reimbursement rate development, and provider contract change analysis for Medicaid Managed Care & Medicare Advantage D‑SNP Plan. This role utilizes advanced SQL, claims data analysis, and financial modeling techniques to assess the financial impact of provider contracts, including fee for service, capitation, and value based arrangements, while ensuring alignment with state regulatory requirements, quality initiatives, and organizational affordability objectives.
Serving as a subject matter expert in provider reimbursement and value based payment analytics, this position supports data‑driven contracting, negotiation, and provider performance strategies through close collaboration with Provider Contracting, Provider Relations, Quality, and IT/Data Analytics departments.
Duties and Responsibilities- Perform detailed financial impact analysis for:
- New provider contracts
- Contract renewals, amendments, and rate adjustments
- Benefit changes, carve ins/outs, and escalators
- Value based contracting arrangements, including shared savings, shared risk, quality incentives, and performance based payments
- Analyze utilization, unit cost, PMPM, and total cost of care impacts using historical claims and encounter data.
- Support facility, professional, and ancillary provider reimbursement structures across the Medicaid and Medicare lines of business, including capitation, fee‑for‑service (FFS), and value based payment models or hybrid models.
- Develop provider reimbursement models including:
- Fee for service (CPT/HCPCS, DRG, APC)
- Case rates, per diems, and bundled payments
- Capitation, value based payments, and alternative payment models (APMs)
- Build scenario based financial models—covering upside and downside risk—to support contracting negotiations and leadership decisions.
- Develop financial methodologies to support value based contract components such as incentive pools, withholds, risk corridors, benchmarks, and performance thresholds.
- Ensure contract financial assumptions align with:
- Medicaid state contract and value based purchasing requirements
- CMS Medicaid Managed Care Guidance
- Network adequacy, access, quality, and affordability standards
- Use advanced SQL to:
- Extract, transform, and analyze large Medicaid claims datasets
- Develop custom datasets for contract modeling, reimbursement analysis, and value based performance measurement
- Validate utilization, unit cost, trend, and attribution assumptions used in financial and VBC models
- Analyze provider performance against cost, utilization, and quality metrics tied to value based arrangements, including calculation of earned incentives, shared savings, or losses.
- Create reproducible, well documented SQL queries to support ongoing contract evaluations and value based reconciliations.
- Partner with data analytics teams to ensure data integrity, consistency, and appropriate methodology for both reimbursement and VBC reporting.
- Partner closely with Provider Contracting to support negotiations with data backed financial insights across fee for service and value based agreements.
- Collaborate with Provider Network, Quality and Clinical teams to align financial models, benchmarks, and performance targets for value based contracts.
- Translate complex analytical findings into clear, actionable messages for non‑finance stakeholders, including summaries of value based performance, risks, and opportunities.
- Document assumptions, methodologies, benchmarks, and reconciliation logic supporting provider contract financial reviews and value based arrangements.
- Ensure analyses comply with:
- CMS & State Regulations
- State specific reimbursement and value based purchasing requirements
- Internal financial controls and…
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