Job Family:Business Systems Analysis
Travel Required:Up to 10%
Clearance Required:None
What You Will Do:The
Senior Healthcare Payer Performance Analyst supports payer performance, reimbursement, and contract management initiatives through the analysis of complex claims, contracts, fee schedules, and reimbursement data. This role requires strong analytical judgment, healthcare reimbursement and contract expertise, and the ability to independently investigate issues, identify trends and opportunities, and translate complex data into actionable insights and recommendations.
The ideal candidate is a highly analytical problem solver who can synthesize information from multiple data sources, evaluate financial and operational impacts, perform root-cause analysis, and effectively communicate findings to internal stakeholders, leadership, and clients. Success in this role requires advanced Excel proficiency, intellectual curiosity, strong business acumen, and the ability to present complex concepts clearly.
In this role you will:
- Analyze complex physician, facility, and ancillary contract terms, claims data, fee schedules, and reimbursement outcomes to support contract management, modeling, performance monitoring, and issue resolution.
- Develop data-driven analyses to identify trends, variances, discrepancies, and financial or operational impacts related to payer contract performance and reimbursement accuracy.
- Perform root-cause analysis using contract requirements, claim details, payment data, and operational workflows to distinguish contract configuration, interpretation, reimbursement, and claims-processing issues.
- Use Excel and other business intelligence or analytics tools to organize, validate, interpret, summarize, and present complex healthcare data in support of reporting, issue resolution, and decision-making.
- Lead analysis workstreams, synthesize findings, prepare clear deliverables, and present conclusions and recommendations to internal stakeholders, operational leaders, and other audiences as needed.
- Partner with contracting, reimbursement, operations, analytics, and leadership teams to clarify requirements, resolve issues, and align contract terms, data outputs, and operational processes.
- Manage multiple priorities while maintaining a high degree of accuracy, attention to detail, sound judgment, and timely delivery in a data-intensive environment.
What You Will Need:- Bachelor's degree in healthcare administration, business, finance, or a related field.
- 5-7+ years of experience in healthcare data analysis, reimbursement analytics, contract management, managed care, revenue cycle, payer/provider contracting, or a related healthcare operations environment.
- Strong understanding of healthcare reimbursement concepts, provider and payer contract language, fee schedules, contract interpretation, and how contract terms translate into data and payment outcomes.
- Experience performing payment variance analysis, root-cause analysis, and issue resolution in a healthcare setting.
- Advanced analytical and critical-thinking skills, with the ability to evaluate large or complex data sets, identify actionable insights, and translate findings into practical recommendations.
- Strong knowledge of medical terminology and healthcare coding concepts, including CPT, HCPCS, ICD, and revenue codes.
- Advanced Microsoft Excel and Office proficiency, including experience organizing, analyzing, validating, summarizing, and presenting data; experience with business intelligence, reporting, or analytics tools is preferred.
- Excellent written, verbal, communication, and presentation skills, including the ability to lead discussions, present analytical findings, and explain complex contract, reimbursement, and data concepts clearly to non-technical stakeholders and leadership.
- Demonstrated ability to work independently, exercise sound judgment, manage high-complexity analytical assignments, and communicate risks, findings, and recommendations effectively.
What Would Be Nice To Have:- Experience with FinThrive.
- Experience with Epic
The annual salary range for this position is $89,000.00-$148,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.
What We Offer:Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.
Benefits include:
- 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
- 401(k) Retirement Plan
- Basic Life & Supplemental Life
- Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
- Short-Term & Long-Term Disability
- Tuition Reimbursement, Personal Development & Learning Opportunities
- Skills Development & Certifications
- Employee Referral Program
- Corporate Sponsored Events & Community Outreach
- Emergency Back-Up Childcare Program
