Job Overview
Location
Dayton WFH
Job Type
Full-time
Category
Data Science
Date Posted
June 25, 2026
Full Job Description
đź“‹ Description
- • Develop and maintain provider reimbursement models across multiple payment structures including fee schedules, percent-of-Medicare, bundled payments, and case rate arrangements.
- • Perform contract repricing analyses using claims data to assess the financial impact of proposed rate and contract changes.
- • Analyze key financial metrics such as billed charges, allowed amounts, units, and utilization trends to identify cost drivers and performance variation.
- • Support benchmarking of provider reimbursement rates against Medicare, Medicaid, and commercial benchmarks.
- • Evaluate pricing approaches for unlisted or miscellaneous CPT/HCPCS codes by identifying comparable services.
- • Utilize SQL and Python to extract, transform, and analyze large, complex healthcare datasets.
- • Leverage automation and AI-assisted tools to improve efficiency in data processing, variance identification, and reporting.
- • Apply advanced analytical techniques to detect anomalies, outliers, and opportunities for cost containment.
- • Perform scenario modeling to evaluate the financial and operational implications of alternative reimbursement structures.
- • Partner with contracting, finance, and operational teams to support rate development and network strategy initiatives.
- • Provide analytical support for reimbursement assessments and contracting decisions.
- • Collaborate with configuration, actuarial, data engineering, and clinical teams to ensure alignment between contract terms, system configuration, and analytical outputs.
- • Participate in requirements gathering, data validation, and issue resolution activities related to reimbursement logic.
- • Support the implementation and refinement of reimbursement logic within claims processing systems.
- • Interpret complex healthcare data and translate findings into actionable insights for technical and non-technical stakeholders.
- • Maintain high accuracy and attention to detail in all data validation and reporting tasks.
- • Manage multiple priorities effectively in a fast-paced environment with strong time management and problem-solving skills.
- • Communicate technical concepts clearly and effectively through written and verbal channels.
- • Work independently and collaboratively within cross-functional teams to achieve organizational goals.
🎯 Requirements
- • Bachelor’s degree in Healthcare Administration, Data Analytics, Finance, Economics, or related field (or equivalent years of relevant work experience)
- • Two (2) years of experience in healthcare reimbursement, provider contracting, or claims data analysis
- • Experience working with healthcare claims data and reimbursement methodologies
- • Proficiency in SQL for data extraction, transformation, and analysis
- • Working knowledge of Python or similar languages for data analysis and automation
- • Familiarity with business intelligence tools such as Power BI or Tableau
🏖️ Benefits
- • Salary range of $72,200.00 - $115,500.00
- • Bonus opportunity tied to company and individual performance
- • Comprehensive total rewards package including well-being initiatives
- • Remote work option (WFH)
- • Opportunity to work with AI-enabled analytic tools and automation technologies
- • Collaborative workplace culture with emphasis on partnership and personal excellence
Skills & Technologies
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About CareSource Management Group Company
CareSource is a nonprofit, multi-state managed care organization headquartered in Dayton, Ohio. Founded in 1989, it administers Medicaid, Medicare Advantage, and Marketplace health plans serving over two million members in Ohio, Kentucky, Indiana, West Virginia, and Georgia. The company focuses on improving health outcomes for low-income and vulnerable populations through integrated care management, behavioral health services, and social determinants programs.
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