Managed Care Payer Contract Analyst

Triwill Group; United States; Hybrid; USD 90,000 - 125,000; Full time

Benefits offered by this job

Medical benefits

401k plan

Job summary

Tribunus Health is seeking a Payer Contract Analyst to drive contract analytics, scenario modeling, and reimbursement insights across hospital and professional services. You will partner with teams to model DRG case rates, carve-outs, and fee schedules, ensuring accurate implementations.

The role emphasizes advanced Excel/PowerPoint use, cross-functional collaboration, and delivering actionable analyses to support negotiations and strategy. Flexible location and part-time options are considered.

Qualifications

• Hospital contract modeling experience is required.
• Ability to build expected-reimbursement logic from a contract and work in unfamiliar models.
• Professional fee schedule modeling experience is required.
• Proficiency in contracting analytics to inform decisions and assess provider value.
• Strong skills in Excel and PowerPoint for data analysis and presentation.
• Excellent written and verbal communication with solid project management.

Responsibilities

• Contract & Scenario Modeling: translate contract language into reimbursement and build flexible models.
• Training and Support: serve as expert resource and trainer on methodologies and fee schedule analysis.
• Data Vendor Lead: manage relationships with data vendors and communicate updates.
• Strategic Data Utilization: analyze contracts and reimbursements to inform strategy.
• Performance Monitoring: validate payer rate loads and analyze variances.
• Market & Policy Research: monitor policy updates and quantify impact on contracts.
• Cross-Functional Support: assist leadership on ad-hoc projects and data tracking.

Education

Bachelor’s Degree Finance, Healthcare Administration, Business or related field.

Tools

Excel

PowerPoint

Contract Modeling tools

Price transparency data sources

Job description

Description: The Role

The Payer Contract Analyst is the analytical engine behind our work, providing crucial insights to support a variety of Tribunus accounts. The Analyst's mission is to perform robust scenario modeling and harness reimbursement data to inform managed care contract negotiations, monitor contract performance, and assess the impact of industry trends and government regulations. You will collaborate closely with Tribunus team members to understand their needs and act as a trusted analytics delivery partner to help maximize negotiation outcomes.

The ideal candidate will have, throughout their career, demonstrated the ability to answer pertinent business questions using all available data assets and achieve targeted outcomes both individually and in team settings. Experience performing contract analytics in a hospital setting is required. If you have had to decide whether stoploss applies before or after the lesser-of-charges comparison, this role will feel familiar.

We are looking for someone to join our team in a full-time capacity, but are open to discussing part-time scenarios. Location is flexible, with many individuals remote and hubs in Charlottesville, VA, WashingtonD.C., and Philadelphia, PA.

What You’ll Do

• Contract & Scenario Modeling: Translate contract language into expected reimbursement and build flexible models that support scenario development. Our hospital work spans DRG case rates, tiered per diems, percent-of-charge, APC and EAPG outpatient methodologies, implant and high-cost drug carve-outs, and stoploss, outlier, and lesser-of-charges provisions; our professional work spans conversion-factor and fee schedule arrangements. Models aggregate fee-for-service and value-based data from multiple sources.
• Training and Support: Serve as an expert resource and trainer for colleagues on hospital and professional reimbursement methodologies and fee schedule analysis.
• Data Vendor Lead: Lead relationships with applicable data vendors (price transparency, claim utilization, etc.) and disseminate information about updates and functionality improvements.
• Strategic Data Utilization: Analyze contracts and historical reimbursements to inform strategy and shape contract proposals.
• Performance Monitoring: When included in a client engagement, validate payer rate loads to ensure contracts are being executed accurately and perform root-cause analysis of variances.
• Market & Policy Research: Monitor payer policy updates and quantify the impact of potential material harm and other contract implications.
• Cross-Functional Support: Serve as a resource to company leadership to assist in ad-hoc projects and update internal tracking systems as analytical work is completed.

Qualifications

• Bachelor’s Degree Finance, Healthcare Administration, Business or related field.
• 5+ years in payer-related roles within the provider or insurance industry, including at least 3 years in net revenue reimbursement modeling, financial analysis, and performance computation.
• Hospital contract modeling experience is required. You should be equally comfortable building expected-reimbursement logic from a contract and working inside a model you didn't write — including one a client or a payer built to support their own number. Professional fee schedule modeling experience is also required.
• Proficiency in contracting analytics, with the ability to harness reimbursement data to inform decisions and quickly assess a provider's value relative to its competitors.
• Intermediate to advanced capabilities with Microsoft Excel and PowerPoint, along with experience building and manipulating Contract Modeling tools and extracting data from online databases (price transparency, etc.).
• Strong project management skills, excellent attention to detail, and efficient conceptualization and logic skills.
• Excellent written and verbal communication skills, including strong internal customer service orientation.

Compensation & Structure

We are committed to transparency and equity in our hiring process and offer competitive benefits.

Expected Base Salary range: $90,000 - $125,000. In compliance with wage transparency laws in many of the jurisdictions in which we recruit, we provide this information. Note that all salary ranges are subject to adjustment based on experience, education, location and other factors relevant to the position.

Performance Bonus: Eligible for additional annual performance bonus based on organizational scaling metrics.

Flexibility: We are open to part-time and hourly arrangements.

Benefits: For full-time individuals, additional benefits include a comprehensive medical benefits package and employer contribution to a 401k plan.

What Makes Tribunus Health Different

Our people are our edge. We’re a mission-driven, high-performing team that works hard, learns fast, and shows up for one another. We believe in clear communication, mutual respect, and doing work that has real impact—for our clients and the healthcare system.

We live by these values:

• Candor: We believe that honesty is empowering.
• Bias for action: We are solutions oriented.
• Collaboration: We are committed to client success.
• Expertise: We develop a deep understanding of our industry, clients, landscape.
• Innovation: We strive to be the first to know and first to act.

Equal Opportunity Employer

Tribunus Health is proud to be an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.