Value-Based Expert

Responsibilities:

• Deliver advanced reimbursement, financial impact, and performance analyses to support managed care negotiations and payer strategy.
• Design and evaluate value-based payment models, including shared savings, quality measures, risk corridors, and attribution methodologies.
• Develop pro forma models and conduct sensitivity and stress testing to assess the financial impact of contract changes, cost initiatives, and market trends.
• Monitor contract and value-based program performance, identifying underpayments, compliance issues, adverse payment trends, and financial risk.
• Produce monthly forecasts and financial reports covering value-based performance, reconciliation, and variance analysis.
• Lead quarterly and annual reconciliation audits to ensure payer compliance and identify contract performance gaps.
• Create scalable tools, analytics, and executive-level visualizations to forecast value-based performance and support enterprise decision-making.
• Mentor managed care analysts and contribute to analytical standards and process improvements

Qualifications:

• 5-7+ years of progressive experience in healthcare finance, payer analytics, medical economics, or related healthcare consulting (required)
• Demonstrated experience supporting value-based contract development, including performance measurement, attribution/quality metrics, reconciliation, and dispute resolution/appeals processes (required)
• Experience with forecasting, audit, and predictive analytics. to support negotiation and contract performance management (required)
• Advanced proficiency in SQL, Tableau, and/or Power BI. Demonstrated experience extracting, validating, and analyzing large healthcare claims, reimbursement, and/or value-based performance datasets (required)
• Demonstrable track record of building analytics that drive business decisions and actions.
• Strong communication skills with the ability to translate complex data into strategic insights for both technical and non-technical audiences (required)
• Familiarity with actuarial concepts such as IBNR and financial reporting under shared-savings or risk-based arrangements. Deep understanding of CMS programs (Medicare Advantage, Medicaid) and HCC risk adjustment methodologies. (preferred)