Director, Provider Network & Analytics

Francisco Partners; United States; On-site; USD 120,000 - 190,000; Full time

Job summary

Avalon Healthcare Solutions is seeking a Director, Provider Network & Analytics to lead enterprise-wide analytics initiatives and partner with executive leadership.

You will leverage healthcare data, reimbursement methodologies, and CPT/HCPCS coding to deliver insights that drive strategy, contracting, and growth. Remote work is possible with periodic travel to our Tampa, FL office.

Strong communication and leadership are essential to translate complex findings into actionable recommendations.

Qualifications

• 10+ years of progressive experience in healthcare analytics, provider network management, healthcare contracting, reimbursement analysis, or related healthcare business functions
• Experience driving strategic initiatives, leading cross-functional teams, and engaging executive stakeholders
• Advanced analytical capabilities evaluating healthcare coding, pricing, reimbursement, and claims data to support strategic business decisions
• Excel proficiency including financial modeling, data manipulation, and advanced analytical techniques
• Strong working knowledge of healthcare claims data, reimbursement analysis, and CPT/HCPCS coding for analytics and contracts
• Exceptional communication and presentation skills with the ability to influence senior leaders and stakeholders
• Proven ability to translate complex technical information into strategic recommendations for executives
• Experience leading large-scale analytics initiatives and cross-functional collaboration

Responsibilities

• Lead and oversee complex healthcare analytics initiatives to drive strategic planning and financial outcomes
• Apply advanced analytical skills to large datasets, identify trends, and uncover opportunities
• Partner with executive leadership as a trusted analytics advisor, communicating insights, risks, and recommendations
• Develop and deliver executive-level presentations, dashboards, and strategic summaries
• Utilize Excel for contracting, pricing, and reimbursement analytics
• Interpret and analyze healthcare utilization and reimbursement data using CPT coding knowledge
• Support analytics related to healthcare contracting, pricing, utilization, and margin optimization
• Collaborate cross-functionally with finance, contracting, clinical, and operational teams
• Establish best practices for coding and pricing governance and data quality

Skills

Healthcare analytics

Provider network management

Reimbursement analysis

CPT/HCPCS coding

Executive communication

Leadership

Tools

Microsoft Excel

Job description

About Avalon Healthcare Solutions:

Avalon Healthcare Solutions is the nation's leader in diagnostic intelligence, uniquely focused on transforming the role of diagnostic testing across the healthcare ecosystem. Our proprietary Diagnostic Insights Platform delivers evidence-based policies, curated lab networks, and real-time analytics that simplify complex diagnostics, accelerate innovation adoption, and optimize diagnostic investments.

Supporting over 30 health plans and 100 million members nationwide, Avalon partners with payers and providers to ensure diagnostic testing is performed appropriately, efficiently, and at the right time. Our flexible solutions span routine and genetic testing management, automated adherence, and end-to-end diagnostics support-driving measurable value, reduced waste, and improved clinical outcomes.

With unmatched scientific rigor, deep clinical expertise, and a performance-based model, Avalon is redefining how diagnostics power personalized care and healthcare value. You will be part of a team that shapes a new market and business. Most importantly, you will help Avalon to achieve its mission and improve clinical outcomes and health care affordability for the people we serve.

For more information about Avalon, please visit www.avalonhcs.com

Avalon Healthcare Solutions is an Equal Opportunity Employer - Vet/Disability.

This position description is subject to change at any time. As determined by the company based upon business needs, an employee in this position may be required to perform duties and take responsibility for work other than as described in this document.

About the Director, Provider Network & Analytics Position:

The Director, Provider Network & Analytics is responsible for leading enterprise-wide analytics initiatives that inform strategic, operational, and financial decision-making across the organization. Serving as a key partner and advisor to executive leadership, this role leverages complex healthcare data, reimbursement methodologies, pricing models, and coding intelligence to deliver actionable insights that drive informed decision-making, advance organizational priorities, and support business growth. The position provides oversight of provider network analytics with a strong focus on laboratory and payer contracting, reimbursement analysis, financial performance evaluation, and network optimization. The Director, Provider Network & Analytics is accountable for developing and implementing data-driven strategies that improve operational efficiency, enhance contract performance, identify revenue opportunities, and support organizational growth. This role requires advanced analytical capabilities, extensive knowledge of healthcare reimbursement and provider network management, and the ability to effectively communicate complex findings and recommendations to executive leaders and key stakeholders.

This position is eligible for remote work, but quarterly travel will be required to Avalon's corporate office located in Tampa, Florida, as well as occasional client site visits.

Director, Provider Network & Analytics - Essential Functions and Responsibilities:

• Lead and oversee complex healthcare analytics initiatives to drive strategic planning, operational performance, and favorable financial outcomes aligned with company objectives.
• Apply advanced analytical and problemsolving skills to large, complex healthcare datasets, identifying trends and opportunities that inform enterprise decisions.
• Partner with senior and executive leadership as a trusted analytics advisor, supporting both internal decisionmaking and client engagements, clearly communicating insights, risks, and recommendations.
• Develop and deliver executivelevel presentations, dashboards, and strategic summaries.
• Utilize advanced Microsoft Excel skills (including complex formulas, pivot tables, financial modeling, and data analysis) to support contracting, pricing, and reimbursement analytics.
• Interpret and analyze healthcare utilization, reimbursement, and financial data using CPT coding knowledge, particularly as it relates to laboratory and payer contracts.
• Support analytics related to healthcare contracting, including pricing analysis, utilization trends, performance monitoring, and margin optimization.
• Collaborate crossfunctionally with finance, contracting, clinical, and operational teams to ensure datadriven decisionmaking across the organization.
• Establish best practices for coding and pricing governance, and data quality.

Director, Provider Network & Analytics - Minimum Qualifications:

• 10+ years of progressive experience in healthcare analytics, provider network management, healthcare contracting, reimbursement analysis, or related healthcare business functions
• Experience driving strategic initiatives, leading cross-functional teams, and engaging executive stakeholders.
• Demonstrated advanced analytical and problem-solving capabilities in evaluating healthcare coding, pricing, reimbursement, and claims data to support strategic business decisions.
• Expert-level proficiency in Microsoft Excel, including financial modeling, data manipulation, and advanced analytical techniques.
• Strong working knowledge of healthcare claims data, reimbursement analysis, and CPT/HCPCS coding, including the application of coding methodologies to healthcare analytics, reimbursement optimization, pricing strategies, and provider contracting.
• Exceptional communication and presentation skills, with the ability to effectively influence senior leaders and executive stakeholders through clear, concise, and data-driven insights.
• Exceptional written and verbal communication skills, with experience producing executivelevel materials and presentations.
• Proven ability to synthesize and translate complex technical and analytical information into strategic, actionable recommendations for executive leadership and key stakeholders.
• Demonstrated success leading large-scale analytics initiatives and influencing senior leaders and executive stakeholders to achieve organizational objectives.

Director, Provider Network & Analytics - Preferred Qualifications:

• Experience supporting healthcare contracting initiatives, particularly involving clinical laboratories, health plans, provider networks, and value-based care arrangements.
• Strong understanding of healthcare reimbursement methodologies, payer dynamics, contract structures, and performance analytics.
• Demonstrated experience supporting enterprise-wide, cross-functional healthcare analytics programs involving multiple stakeholders and business units.