Sr. Healthcare Provider Contracting Analyst

Job DetailsJob Location: Main Office - Santa Barbara, CA 93110Position Type: Full TimeSalary Range: $120,970.00 - $181,455.00 Salary/yearJob Category: Financial AnalyticsCentral Coast Salary Range: $120,970 - $181,455 

Job Summary
The Senior Financial Analyst - Provider Contracts independently performs complex financial modeling, reimbursement rate development, and provider contract change analysis for Medicaid Managed Care & Medicare Advantage D-SNP Plan. This role utilizes advanced SQL, claims data analysis and financial modeling techniques to assess the financial impact of provider contracts including fee for service, capitation, and value based arrangements, while ensuring alignment with state regulatory requirements, quality initiatives, and organizational affordability objectives.
Serving as a subject matter expert in provider reimbursement and value based payment analytics, this position supports data driven contracting, negotiation, and provider performance strategies through close collaboration with Provider Contracting, Provider Relations, Quality, and IT/Data Analytics departments.
Key areas of responsibility include, but are not limited to: 



Provider Contract Financial Analysis


Rate Development Modeling


Advanced SQL & Data Analysis


Cross-Functional Partnership & Strategic Support


Data Governance, Accuracy & Regulatory Compliance


Leadership, Mentorship & Operational Support


Other duties as assigned



Duties and Responsibilities
1.    Provider Contract Financial Analysis



Perform detailed financial impact analysis for:



New provider contracts


Contract renewals, amendments, and rate adjustments


Benefit changes, carve ins/outs, and escalators


Value based contracting arrangements, including shared savings, shared risk, quality incentives, and performance based payments




Analyze utilization, unit cost, PMPM, and total cost of care impacts using historical claims and encounter data.


Support facility, professional, and ancillary provider reimbursement structures across the Medicaid and Medicare lines of business, including capitation, fee-for-service (FFS) and value based payment models or hybrid models.



2.    Rate Development & Modeling



Develop provider reimbursement models including:



Fee for service (CPT/HCPCS, DRG, APC)


Case rates, per diems, and bundled payments


Capitation, value based payments, and alternative payment models (APMs)




Build scenario based financial models—covering upside and downside risk—to support contracting negotiations and leadership decisions.


Develop financial methodologies to support value based contract components such as incentive pools, withholds, risk corridors, benchmarks, and performance thresholds.


Ensure contract financial assumptions align with:



Medicaid state contract and value based purchasing requirements


CMS Medicaid Managed Care Guidance


Network adequacy, access, quality, and affordability standards





3.    Advanced SQL & Data Analysis



Use advanced SQL to:



Extract, transform, and analyze large Medicaid claims datasets


Develop custom datasets for contract modeling, reimbursement analysis, and value based performance measurement


Validate utilization, unit cost, trend, and attribution assumptions used in financial and VBC models




Analyze provider performance against cost, utilization, and quality metrics tied to value based arrangements, including calculation of earned incentives, shared savings, or losses.


Create reproducible, well documented SQL queries to support ongoing contract evaluations and value based reconciliations.


Partner with data analytics teams to ensure data integrity, consistency, and appropriate methodology for both reimbursement and VBC reporting.



4.    Cross Functional Partnership & Strategic Support



Partner closely with Provider Contracting to support negotiations with data backed financial insights across fee for service and value based agreements.


Collaborate with Provider Network, Quality and Clinical teams to align financial models, benchmarks, and performance targets for value based contracts.


Translate complex analytical findings into clear, actionable messages for non finance stakeholders, including summaries of value based performance, risks, and opportunities.



 
5.    Data Governance, Accuracy & Regulatory Compliance



Document assumptions, methodologies, benchmarks, and reconciliation logic supporting provider contract financial reviews and value based arrangements.


Ensure analyses comply with:



CMS & State Regulations


State specific reimbursement and value based purchasing requ