Guidehouse
Healthcare
HealthcareAnalytics–Payor/ProviderFinanceDataandAI,ManagedCareContracting&Optimization
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“Healthcare Analytics – Payor/Provider Finance Data and AI, Managed Care Contracting & Optimization at Guidehouse. Skills: Healthcare analytics, Managed care contracting, Data modeling, SQL, Python, ETL/ELT, BI tools (Power BI/Tableau). Interpret payer contracts. Model reimbursement terms”
What You'll Achieve.
Measurable healthcare financial performance; Ensure modeled rates and rules align with contract language and adjudication behavior; Turn findings into clear, executive-ready recommendations; Contract performance (e.g. , allowed vs. expected, underpayment/overpayment detection, denial patterns, yield by payer/product); Connect contract mechanics to RCM KPIs (denial rate, DNFB, AR days, first pass yield, cash acceleration, net revenue)
Industry & Context.
Root cause analysis; Investigate and resolve discrepancies
Travel Required: Up to 10%, Clearance Required: None
What They're Looking For.
Must Have
Bachelor's degree, Minimum THREE (3) years of experience in healthcare analytics, consulting, or adjacent healthcare services with measurable data driven outcomes, Experience building production-grade ETL/ELT processes and implementing data quality frameworks, Proficiency with BI/visualization tools (Power BI or Tableau), Excel skills, Excellent communication
Nice to Have
Hands‑on with Azure Data Factory, Databricks, SSIS (or similar), Understanding of payer/provider operations and payment experience with contract modeling or payment variance analytics is a plus, Experience with Agile practices and Git-based version control, Experience with regulatory reporting and transparency initiatives (e.g. , CMS price transparency, charge master reviews)
What You'll Do.
Interpret payer contracts
Model reimbursement terms
Enhance modeling tools with automation
Validate modeled results
Investigate and resolve discrepancies
Maintain a controlled library of contract models
Build/optimize ETL/ELT pipelines
Implement QA/validation checks
Automate contract lookups
case mix normalization
and variance analytics using SQL
Use Python for parsing artifacts
applying calculation engines
regression/variance checks
and generating validation reports
Develop BI dashboards for contract performance
Present findings connecting contract mechanics to RCM KPIs
and operationalization with stakeholders
Support pursuits showcasing contract modeling capabilities
Enhance contract modeling tooling
Contribute reusable assets
Uphold SDLC/Agile practices and code review standards
How You'll Work.
Team & Collaboration
Partner with contracting, revenue integrity, and patient financial services teams; Work with Managed Care/Finance, Revenue Integrity/CDM, PFS, and IT/Data teams; Collaborative teammate
Communication Scope
Excellent communication; Able to translate technical and contractual details into concise, executive-ready insights; Present findings
Process & Methodology
Comfortable leading workstreams, Agile practices, SDLC
Full Job Description
**_Job Family_ :** Data Science Consulting ** _Travel Required_ :** Up to 10% **_Clearance Required_ :** None ## ** _What You’ll Do_** : The Healthcare Finance Data and AI team translates healthcare data into measurable healthcare financial performance. This role is dedicated to managed care contracting – you will learn to read payer contracts (commercial and government), model reimbursement terms in our existing tools, and enhance those tools with automation using SQL and Python. You will partner with contracting, revenue integrity, and patient financial services teams to ensure our modeled rates and rules align with contract language and adjudication behavior, and you will turn findings into clear, executive-ready recommendations. * Learn and interpret payer contracts (fee schedules, DRG/APC, per diem, percent-of-charge, case rates, carveouts, stoploss/outlier, multiple procedure reductions, modifiers, bundling/packaging rules, lesser-of logic, escalators, effective dates, term/renewal, amendments). * Translate contract terms into machine-readable logic and configure/model those terms in our existing pricing/adjudication tools. * Validate modeled results by reconciling remittance advice (835/ERA) and historical payments; investigate and resolve discrepancies with root cause analysis. * Maintain a controlled library of contract models (versioning, effective/expiry dates, audit trail, documentation of assumptions). * Build/optimize ETL/ELT pipelines to ingest fee schedules and contract artifacts; implement QA/validation checks (e.g., dimensional completeness, rate reasonableness, variance thresholds). * Use advanced SQL (window functions, CTEs, stored procedures, query tuning) to automate contract lookups, grouper logic, case mix normalization, and variance analytics. * Use Python (preferred) for parsing artifacts, applying calculation engines, regression/variance checks, and generating repeatable validation reports. * Develop Power BI/Tableau dashboards for contrac
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