Job Summary:The Provider Contracting Analyst II supports the development, validation, and optimization of provider reimbursement strategies through advanced data analysis, financial modeling, and AI-enabled analytic tools. This role is responsible for evaluating provider payment methodologies, conducting contract repricing analyses, and delivering actionable insights to support contracting decisions. They apply modern analytics techniques-including automation and artificial intelligence-to enhance accuracy, scalability, and efficiency in reimbursement modeling and reporting.
Essential Functions:- Develop and maintain provider reimbursement models across multiple payment structures, including fee schedules, percent-of-Medicare, bundled payments, and case rate arrangements.
- Perform contract repricing analyses using claims data to assess financial impact of proposed rate and contract changes.
- Analyze key financial metrics, including billed charges, allowed amounts, units, and utilization trends, to identify cost drivers and performance variation.
- Support benchmarking of provider reimbursement rates against applicable Medicare, Medicaid, and commercial benchmarks.
- Assist in evaluating pricing approaches for unlisted or miscellaneous CPT/HCPCS codes by identifying comparable services.
- Utilize SQL, Python, and business intelligence tools to analyze large, complex healthcare datasets.
- Leverage automation and AI-assisted tools to improve efficiency in data processing, variance identification, and reporting.
- Apply advanced analytical techniques to identify anomalies, outliers, and opportunities for cost containment.
- Perform scenario modeling to evaluate the financial and operational implications of alternative reimbursement structures.
- Partner with contracting, finance, and operational teams to support rate development and network strategy initiatives.
- Provide analytical support for reimbursement assessments.
- Collaborate with configuration, actuarial, data engineering, and clinical teams to ensure alignment between contract terms, system configuration, and analytical outputs.
- Participate in requirements gathering, data validation, and issue resolution activities.
- Support implementation and refinement of reimbursement logic within claims processing systems.
- Perform any other job related duties as requested.
Education and Experience:- Bachelor's degree in Healthcare Administration, Data Analytics, Finance, Economics or related field required
- Equivalent years of relevant work experience may be accepted in lieu of required education
- Two (2) years of experience in healthcare reimbursement, provider contracting or claims data analysis required
- Experience working with healthcare claims data and reimbursement methodologies required
- Experience with data analytics tools, automation, or AI enabled technologies preferred
Competencies, Knowledge and Skills:- Understanding of healthcare reimbursement methodologies, including Medicare, Medicaid, and commercial payment models
- Familiarity with CPT/HCPCS coding, DRGs, APCs, and related billing constructs
- Knowledge of provider contracting structures and pricing strategies
- Proficiency in SQL for data extraction, transformation, and analysis
- Working knowledge of Python or similar languages for data analysis and automation
- Familiarity with business intelligence tools such as Power BI or Tableau
- Familiarity with analytics automation and AI-assisted tools
- Strong analytical and quantitative reasoning skills
- Ability to interpret complex data and translate it into actionable insights
- High attention to detail with a focus on accuracy and validation
- Ability to effectively communicate technical concepts to both technical and non-technical audiences
- Strong written and verbal communication skills
- Ability to work independently and collaboratively in a team environment
- Ability to manage multiple priorities in a fast-paced environment
- Strong time management and problem-solving skills
Licensure and Certification:Working Conditions:- General office environment; may be required to sit or stand for extended periods of time
- Travel is not typically required
Compensation Range:$72,200.00 - $115,500.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):Salary
Organization Level Competencies - Fostering a Collaborative Workplace Culture
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time.#LI-EM1
Brand=CareSource
