Guidehouse · 1 day ago
Healthcare Analytics – Payor/Provider Finance Data and AI, Managed Care Contracting & Optimization
US - IL, Chicago
Full-time
Onsite
Mid Level
$102K/yr - $170K/yr
3+ years expGuidehouse is a consulting firm that specializes in data science and analytics services. The Healthcare Analytics role focuses on translating healthcare data into financial performance insights, particularly in managed care contracting, while collaborating with various teams to ensure accurate modeling and reporting.
AdviceConsultingManagement Consulting
Responsibilities
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
Qualification
Required
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 communication—able to translate technical and contractual details into concise, executive-ready insights
Detail oriented, self-directed, collaborative teammate comfortable leading workstreams
Preferred
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)
Benefits
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
Company
Guidehouse
Guidehouse offers consulting services for public and commercial markets with expertise in management, technology, and risk consulting.
10001+ employees
H1B Sponsorship
Guidehouse has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (25)
2024 (20)
2023 (29)
2022 (49)
2021 (50)
2020 (59)
Funding
Current Stage
Late StageTotal Funding
$0.75MKey Investors
Mission Daybreak
2023-11-06Acquired
2023-02-16Grant· $0.75M
Leadership Team
Scott McIntyre
Chairman and CEO
Alicia Harkness
Partner
Recent News
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2025-11-20
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