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
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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