Provider Contract, Cost of Care Consultant
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Richmond • Ohio • Virginia • United States
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Tech Stack
About the role
- Provides analytical support to the Cost of Care and/or Provider Contracting organizations
- Focuses efforts on lowering claims costs
- Improves the quality of care
- Increases member and provider network satisfaction
- Provides expert advice, analytic and consultative support to Medical Directors and management on cost of care issues
- Works on large scale initiatives with high dollar cost savings opportunities
- Works on complex enterprise-wide initiatives and acts as project lead
- Uses analytic tools to track both health risks and compliance
- Supports the contract negotiation process
- Performs sophisticated retrospective data analytics
- Builds new and modifies existing complex models to create predictive impact decision making tools
- Performs healthcare cost analysis to identify strategies to control costs
- Projects cost increases in medical services by using analytic techniques for PMPM trending via multiple variable analysis
- Performs modeling to compare various contract scenarios based on member utilization patterns and 'what if' logic
- Researches the financial profitability/stability and competitive environment of providers to determine impact of proposed rates
- Projects different cost of savings targets based upon various analytics
- Identifies cost of care savings opportunities by analyzing practice patterns in relation to office visits, referral practices, and specialty care procedures
- Recommends policy changes and claims system changes to pursue cost savings
- Reviews results post-implementation to ensure projected cost savings are realized and recommends modifications as applicable
- Recommends standardized practices to optimize cost of care
- Educates provider contractors on contracting analytics from a financial impact perspective
- Recommends alternative contract language and may go on-site to provider premises during contract negotiations
- Participates on project team involved with enterprise-wide initiatives
- Acts as a source of direction, training and guidance for less experienced staff
Requirements
- Requires BS/BA degree in Mathematics, Statistics, or related field
- minimum of 5 years of experience in broad-based analytical, managed care payor or provider environment
- considerable experience in statistical analysis and healthcare modeling
- Duals experience highly preferred
- Proficiency in data manipulation tools such as SQL, SAS, or similar highly preferred
- Exceptional analytical, organizational, presentation, and problem-solving skills preferred
- Cost of care analysis knowledge preferred
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
statistical analysishealthcare modelingdata analyticscost analysispredictive modelingdata manipulationPMPM trendingcomplex modelingretrospective data analyticscontract negotiation
Soft Skills
analytical skillsorganizational skillspresentation skillsproblem-solving skillsconsultative supportleadershiptrainingguidance