Contract

Payer Analytics Consultant

Central California Alliance for Health

Central California Alliance for Health

Compensation Overview

$58 - $72/hr

No H1B Sponsorship

California, USA

Hybrid

Hybrid role; remote work possible for CA residents, with in-person attendance at select meetings/events.

Category
Finance & Banking (2)
,
Required Skills
Data Science
SQL
Financial analysis
Word/Pages/Docs
Tableau
Excel/Numbers/Sheets
Financial Modeling
PowerPoint/Keynote/Slides
Requirements
  • Knowledge of Windows based PC systems and Microsoft Word, Outlook, PowerPoint, Access, Visual Basic, and Excel (including pivot tables), and database systems
  • Methods and techniques of financial modeling and analysis
  • Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers
  • Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider types
  • National standards for fee-for-service and value-based provider reimbursement methodologies, including risk-sharing models
  • Data modeling techniques and business analytical and data mining tools, including SQL, and data visualization tools, such as Tableau
  • Bachelor’s degree in Business Administration, Accounting, Finance, Healthcare, or a related field
  • A minimum of three years of experience performing financial healthcare reimbursement analysis (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying
Responsibilities
  • Designs and validates managed care payer models and performs moderately complex analysis to evaluate the feasibility of payer reimbursement methodologies
  • Conducts moderately complex financial analysis to support successful payer reimbursement outcomes
  • Coordinates and collaborates with internal and external stakeholders to achieve payer reimbursement objectives
Central California Alliance for Health

Central California Alliance for Health

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Simplify Jobs

Simplify's Take

What believers are saying

  • $44.9 million invested in 2025 expands care access and strengthens local health infrastructure.
  • Value-based care incentive programs position Alliance to capture outcome-based reimbursement as payers shift models.
  • Geographic diversification into Monterey County opens new revenue streams and member acquisition opportunities.

What critics are saying

  • California Medi-Cal redetermination unwinds 10-20% member base within 6-12 months post-pandemic.
  • L.A. Care's aggressive expansion into Monterey and Santa Cruz counties directly poaches primary networks.
  • State budget deficit triggers 15% capitation rate cuts, eroding $800M revenue base by mid-2026.

What makes Central California Alliance for Health unique

  • Regional scale of 430,000+ Medi-Cal members across five-county service area enables provider negotiation leverage.
  • Housing Fund and Community Health Worker programs address social determinants beyond traditional managed care.
  • 30-year operational history as regional Medi-Cal plan demonstrates sustained execution in complex market.

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Benefits

Health Insurance

Dental Insurance

Vision Insurance

Ample Paid Time Off

12 Paid Holidays per year

401(a) Retirement Plan

457 Deferred Compensation Plan

Robust Health and Wellness Program

Onsite EV Charging Stations