Provider Contract/CofC Analyst Sr.

$75,516 - $129,456/Yr

Elevance Health - Miami, FL

- Mid Level

Miami, FL

Insurance Carriers and Related Activities

About the position

The Provider Contract/Cost of Care Analyst Sr. is responsible for 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. hospital, physician, ancillary, or medical group. Provides advice and analytic support to contract negotiators, Medical Directors and management on cost of care issues to help reduce costs without compromising quality of care.

Responsibilities

• Utilizes programming logic for data extraction, mining, and manipulation.
• Performs varied data research and analyses.
• Develops moderately complex ROI models and 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.
• Prepares pre-negotiation analyses to support development of defensible pricing strategies.
• Performs modeling to compare various contract scenarios based on member utilization patterns and 'what if' logic.
• Measures and evaluates the cost impact of various negotiation proposals.
• 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 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.
• Minimum of 3 years experience in broad-based analytical, managed care payor or provider environment.
• Experience in statistical analysis and healthcare modeling.

Nice-to-haves

• Master's degree preferred.
• Strong analytical and communication skills.
• Microsoft Excel & Access intermediate-to-advanced knowledge preferred.
• SAS, SQL or other programming logic suggested, but not required.
• Managed Care / Health Insurance / Payor reimbursement knowledge preferred.
• Diagnosis Related Group (DRG), Revenue Code, Healthcare Common Procedure Coding System (HCPCS), and Current Procedural Terminology (CPT) knowledge preferred.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution.