Sr. Financial Analyst - Provider Contracts

While candidates from anywhere in California are welcome to apply, there is a strong preference for those who reside on the Central Coast (Ventura, Santa Barbara, San Luis Obispo, Monterey and Santa Cruz Counties). This role may offer opportunities for remote work; however, familiarity with and proximity to our local customers is valued. We are seeking a highly analytical and strategic Senior Financial Analyst - Provider Contracts to support the financial performance and reimbursement strategy of our Medicaid Managed Care and Medicare Advantage D-SNP health plans. This role is ideal for a healthcare finance professional with deep expertise in provider reimbursement, advanced SQL analytics, and value-based care modeling. As a key subject matter expert, you will lead complex provider contract financial analysis, reimbursement rate development, and value-based payment modeling while partnering closely with Provider Contracting, Quality, Clinical, and Data Analytics teams to support data-driven decision-making and affordability initiatives. What You'll Do Provider Contract Financial Analysis Perform detailed financial impact analyses for: New provider contracts Contract renewals and amendments Rate adjustments and benefit changes Value-based payment arrangements including shared savings, shared risk, and quality incentives Analyze utilization, PMPM, unit cost, and total cost of care trends using healthcare claims and encounter data Support reimbursement structures across Medicaid and Medicare lines of business including: Fee-for-service (FFS) Capitation Value-based and hybrid payment models Rate Development & Financial Modeling Develop reimbursement methodologies including: CPT/HCPCS, DRG, and APC fee schedules Case rates, bundled payments, and per diems Capitation and alternative payment models (APMs) Build complex scenario-based financial models to support provider negotiations and executive decision-making Design methodologies for: Incentive pools Risk corridors Withholds Shared savings/losses Performance benchmarks and thresholds Ensure all models align with CMS guidance, Medicaid managed care requirements, network adequacy standards, and affordability goals Advanced SQL & Healthcare Data Analytics Use advanced SQL to extract, transform, validate, and analyze large healthcare claims datasets Develop custom datasets for: Contract modeling Reimbursement analysis Value-based performance measurement Analyze provider performance against quality, utilization, and cost metrics Create reproducible and well-documented SQL queries and reporting methodologies Partner with Data Analytics teams to ensure data integrity and reporting accuracy Strategic Collaboration & Leadership Support provider contract negotiations with data-backed financial insights Collaborate cross-functionally with Provider Network, Quality, Clinical, and Finance teams Present complex analytical findings in a clear and actionable manner to technical and non-technical audiences Serve as a mentor and subject matter expert for junior analysts Drive process improvements, automation, and standardization initiatives What We're Looking For Required Qualifications Bachelor's degree in Finance, Accounting, Economics, Healthcare Administration, or related field Minimum 5 years of healthcare financial analysis experience Minimum 3 years of provider reimbursement, payment modeling, or provider contract financial analysis experience Experience supporting Medicaid Managed Care or Medicaid lines of business Advanced SQL experience including: Complex joins Subqueries Aggregations Query optimization and performance-conscious design Apply today and help shape the future of healthcare reimbursement and provider partnerships.

Pay:

$120,970.00 - $181,455.00 per year

Benefits:

Dental insurance Employee assistance program Flexible spending account Health insurance Health savings account Paid time off Professional development assistance Referral program Retirement plan Vision insurance

Work Location:

Remote