Cost of Care/Provider Contracting Data Analyst Senior

Elevance Health • Atlanta, GA

6d • Hybrid

About The Position

Cost of Care/Provider Contracting Data Analyst Senior Location: This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Cost of Care/Provider Contracting Data Analyst Senior is responsible for providing analytical support to the Cost of Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider network satisfaction. Typically works with one provider type, e.g. physician, ancillary, or medical group. Provides advice and analytic support to Medical Directors, contract negotiators and management on cost of care issues to help reduce costs without compromising quality of care. How you will make an impact: Developing moderately complex ROI models and performs healthcare cost analysis to identify strategies to control costs. Projecting cost increases in medical services by using analytic techniques for PMPM trending via multiple variable analysis; preparing pre-negotiation analyses to support development of defensible pricing strategies. Performing modeling to compare various contract scenarios based on member utilization patterns and 'what if' logic. Measuring and evaluating the cost impact of various negotiation proposals. Researching the financial profitability/stability and competitive environment of providers to determine impact of proposed rates; and projecting 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 and recommends policy changes and claim's 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. May recommend alternative contract language and may go on-site to provider premises during contract negotiations. Participates on project team involved with enterprise-wide initiatives.

Requirements

• Requires BS/BA degree in Mathematics, Statistics, or related field and a minimum of 3 years experience in broad-based analytical, managed care payor or provider environment as well as experience in statistical analysis and healthcare modeling; or any combination of education and experience which would provide an equivalent background.

Nice To Haves

• Master's degree preferred.
• SQL experience preferred.
• SAS experience preferred.
• Healthcare background preferred.

Responsibilities

• Developing moderately complex ROI models and performs healthcare cost analysis to identify strategies to control costs.
• Projecting cost increases in medical services by using analytic techniques for PMPM trending via multiple variable analysis; preparing pre-negotiation analyses to support development of defensible pricing strategies.
• Performing modeling to compare various contract scenarios based on member utilization patterns and 'what if' logic.
• Measuring and evaluating the cost impact of various negotiation proposals.
• Researching the financial profitability/stability and competitive environment of providers to determine impact of proposed rates; and projecting 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 and recommends policy changes and claim's 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.
• May recommend alternative contract language and may go on-site to provider premises during contract negotiations.
• Participates on project team involved with enterprise-wide initiatives.

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees