Note: The job is a remote job and is open to candidates in USA. Guidehouse is a company specializing in data science consulting, and they are seeking a candidate for their Healthcare Finance Data and AI team. This role focuses on managed care contracting, involving the interpretation of payer contracts, automation of reimbursement terms, and collaboration with various teams to ensure alignment with contract language and financial performance metrics.
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
Skills
- Bachelor's degree is required
- Minimum ONE (1) year 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
- 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 Overview
- Guidehouse offers consulting services for public and commercial markets with expertise in management, technology, and risk consulting. It was founded in 2018, and is headquartered in Washington, District of Columbia, USA, with a workforce of 10001+ employees. Its website is https://guidehouse.com.
Company H1B Sponsorship
- Guidehouse has a track record of offering H1B sponsorships, with 25 in 2025, 20 in 2024, 29 in 2023, 49 in 2022, 50 in 2021, 59 in 2020. Please note that this does not guarantee sponsorship for this specific role.