Senior Consultant, Healthcare Analytics Payor/Provider Finance Data and AI, Managed Care Contracting & Optimization

Healthcare Finance Data And Ai Consultant

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.

Key responsibilities include:

• 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 contract performance (e.g., allowed vs. expected, underpayment/overpayment detection, denial patterns, yield by payer/product).
• Own analytics workstreams; present findings that connect contract mechanics to RCM KPIs (denial rate, DNFB, AR days, first pass yield, cash acceleration, net revenue).
• Work with Managed Care/Finance, Revenue Integrity/CDM, PFS, and IT/Data teams to align interpretation, data sources, and operationalization.
• Support pursuits (POVs, demos) showcasing our contract modeling capabilities and automation.
• Enhance our contract modeling tooling: propose schema/logic improvements, performance tuning, error handling, and test harnesses.
• Contribute reusable assets (SQL/Python modules, validation checklists, samples, documentation); uphold SDLC/Agile practices and code review standards.

Required qualifications include:

• Bachelor's degree is required
• Minimum THREE (3) years of experience in healthcare analytics, consulting, or adjacent healthcare services with measurable data driven outcomes (revenue cycle management exposure strongly preferred).
• Experience building production-grade ETL/ELT processes and implementing data quality frameworks.
• Proficiency with BI/visualization tools (Power BI or Tableau) and strong Excel skills.
• Excellent communicationable 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 methodologies; experience with contract modeling or payment variance analytics is a strong plus (we will train on contract reading).
• Experience with Agile practices and Git-based version control.
• Experience with regulatory reporting and transparency initiatives (e.g., CMS price transparency, charge master reviews).

The annual salary range for this position is $102,000.00-$170,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance
• Personal and Family Sick Time & Company Paid Holidays
• Position may be eligible for a discretionary variable incentive bonus
• Parental Leave and Adoption Assistance
• 401(k) Retirement Plan
• Basic Life & Supplemental Life
• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
• Short-Term & Long-Term Disability
• Student Loan PayDown
• Tuition Reimbursement, Personal Development & Learning Opportunities
• Skills Development & Certifications
• Employee Referral Program
• Corporate Sponsored Events & Community Outreach
• Emergency Back-Up Childcare Program
• Mobility Stipend

Guidehouse is an Equal Opportunity EmployerProtected Veterans, Individuals with Disabilities or any other basis protected by law.