Cost of Care/Provider Contracting Data Analyst
About The Position
Cost of Care/Provider Contracting Data Analyst 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 is responsible for provides 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. How you will make an impact: 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. Partners with provider contractors to develop contracting strategy and supports all aspects of the contract negotiation process. Can work with multiple provider types, e.g. physician, ancillary, medical groups, or hospitals. Supports a full range of contract arrangements and pricing mechanisms. Works on complex enterprise-wide initiatives and acts as project lead. Uses analytic tools to track both health risks and compliance, as well as supporting the contract negotiation process. Types of analyses include performing sophisticated retrospective data analytics; building new and modifying existing complex models to create predictive impact decision making tools 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. 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 experience in broad-based analytical, managed care payor or provider environment
- considerable 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.
- Proficiency with Snowflake, SAS, SQL and Excel is strongly preferred.
- Experience with Tableau is preferred.
- Experience with Value-based programs preferred.
- Health Economics background strongly preferred.
- Healthcare background strongly preferred.
Responsibilities
- 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.
- Partners with provider contractors to develop contracting strategy and supports all aspects of the contract negotiation process.
- Can work with multiple provider types, e.g. physician, ancillary, medical groups, or hospitals.
- Supports a full range of contract arrangements and pricing mechanisms.
- Works on complex enterprise-wide initiatives and acts as project lead.
- Uses analytic tools to track both health risks and compliance, as well as supporting the contract negotiation process.
- Types of analyses include performing sophisticated retrospective data analytics; building new and modifying existing complex models to create predictive impact decision making tools
- 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.
- Acts as a source of direction, training and guidance for less experienced staff.
Benefits
- In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Industry
Insurance Carriers and Related Activities
Number of Employees
5,001-10,000 employees
