Guidehouse
Healthcare
HealthcareAnalytics–Payor/ProviderFinanceDataandAI,ManagedCareContracting&Optimization
“Healthcare Analytics – Payor/Provider Finance Data and AI, Managed Care Contracting & Optimization at Guidehouse. Skills: Healthcare Finance Data and AI, Managed care contracting, Reimbursement modeling, SQL, Python, ETL/ELT pipelines, Power BI/Tableau dashboards. Learn and interpret payer contracts. Translate contract terms into machine-readable logic and configure/model those terms in existing pricing/adjudication tools”
What You'll Achieve.
Translate healthcare data into 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 ONE (1) year of experience in healthcare analytics, consulting, or adjacent healthcare services with measurable data driven outcomes, Experience building production-grade ETL/ELT processes, Implementing data quality frameworks, Proficiency with BI/visualization tools (Power BI or Tableau), Excel skills, Excellent communication—able to translate technical and contractual details into concise, executive-ready insights, Detail oriented, self-directed, collaborative teammate comfortable leading workstreams
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.
Learn and interpret payer contracts
Translate contract terms into machine-readable logic and configure/model those terms in existing pricing/adjudication tools
Validate modeled results by reconciling remittance advice (835/ERA) and historical investigate and resolve discrepancies with root cause analysis
Maintain a controlled library of contract models (versioning
effective/expiry dates
documentation of assumptions)
Build/optimize ETL/ELT pipelines to ingest fee schedules and contract implement QA/validation checks
Use advanced SQL to automate contract lookups
case mix normalization
and variance analytics
Use Python for parsing artifacts
applying calculation engines
regression/variance checks
and generating repeatable validation reports
Develop Power BI/Tableau dashboards for contract performance
Own analytics present findings that connect contract mechanics to RCM KPIs
Support pursuits (POVs
demos) showcasing contract modeling capabilities and automation
Enhance contract modeling tooling: propose schema/logic improvements
Contribute reusable assets (SQL/Python modules
validation checklists
documentation); 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 to align interpretation, data sources, and operationalization
Communication Scope
Excellent communication—able to translate technical and contractual details into concise, executive-ready insights
Process & Methodology
Comfortable leading workstreams
Applying for this Healthcare Analytics – Payor/Provider Finance Data and AI, Managed Care Contracting & Optimization role?
Most applicants get filtered before a human reads their resume. See if yours makes the cut.
How to Apply on Workday
- Workday has a multi-step form — save your progress after every section.
- "Apply With LinkedIn" can fail or lose data; manual entry is more reliable.
- Watch for the "Submit for Review" final step — hitting "Save" alone does not submit.
- Job requisition numbers are useful when following up with HR by email.
ANONYMOUS · UNFILTERED
What do employees actually say about Guidehouse?
Real rants from real employees. Read before you apply.