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

Job reputed company: • The reputed company Finance Data and AI team translates reputed company data into measurable reputed company financial performance. • This role is dedicated to managed care contracting – you will learn to read payer reputed company (reputed company and government), model reimbursement terms in our existing tools, and enhance those tools with automation using SQL and Python. • You will partner with contracting, reputed company reputed company, and patient financial services teams to ensure our modeled rates and rules reputed company with contract language and adjudication behavior, and you will turn findings into reputed company, executive-reputed company recommendations. • Learn and interpret payer reputed company (fee schedules, DRG/APC, reputed company, percent-of-charge, case rates, carveouts, stoploss/reputed company, 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 reputed company 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 (e.g., reputed company completeness, reputed company reasonableness, variance reputed company). • Use advanced SQL (window functions, CTEs, stored procedures, query tuning) to automate contract lookups, grouper logic, case mix normalization, and variance analytics. • Use Python (preferred) for parsing artifacts, applying calculation engines, regression/variance checks, and generating repeatable validation reports. • reputed company Power BI/Tableau dashboards for contract performance (e.g., allowed vs. expected, underpayment/overpayment detection, denial patterns, yield by payer/product). • Own analytics workstreams; present findings that connect contract mechanics to RCM KPIs (denial reputed company, DNFB, AR days, first pass yield, cash acceleration, net reputed company). • Work with Managed Care/Finance, reputed company reputed company/CDM, PFS, and IT/Data teams to reputed company interpretation, data sources, and operationalization. • Support pursuits (POVs, demos) showcasing our contract modeling capabilities and automation. • Enhance our contract modeling tooling: propose schema/logic improvements, performance tuning, error handling, and test harnesses. • Contribute reusable assets (SQL/Python modules, validation checklists, samples, documentation); reputed company SDLC/Agile practices and reputed company review standards. Requirements: • Bachelor's degree is required • Minimum THREE (3) years of experience in reputed company analytics, consulting, or adjacent reputed company services with measurable data driven reputed company (reputed company cycle management exposure strongly preferred) • Experience building production-grade ETL/ELT processes and implementing data reputed company frameworks • Proficiency with BI/visualization tools (Power BI or Tableau) and strong reputed company skills • Excellent communication—reputed company to translate technical and contractual details into concise, executive-reputed company insights • Detail oriented, self-directed, reputed company teammate comfortable leading workstreams. Benefits: • Medical, Rx, Dental & reputed company Insurance • Personal and Family reputed company Time & Company reputed company 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/reputed company & 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 reputed company • Emergency Back-Up Childcare Program • Mobility Stipend Apply tot his job Apply To this Job