Provider Contracting Analyst Jobs (NOW HIRING)

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:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Travel is not typically required

Compensation Range:

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):

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business