Provider Contract/CofC Consultant Senior

Elevance Health•Tampa, FL

6d•Hybrid

About The Position

Provider Contract/CofC Consultant 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 Provider Contract/COC Consultant Sr role provides the highest level of analytical support to the Cost of Care and/or Provider Contracting organizations. In this role, you will lead efforts to support regulatory reporting requirements for government entities and regulatory bodies. Your primary focus will be on gathering, consolidating, analyzing, and submitting data to ensure compliance with healthcare expenditure regulations and initiatives aimed at increasing healthcare service value. How You Will Make an Impact: Serve as a subject matter expert for regulatory reporting, ensuring that all submissions meet internal and external standards for accuracy and compliance. Collaborate with various teams to gather and interpret requirements related to health insurance data reporting. Retrieve, consolidate, and collate data from multiple data warehouses to produce comprehensive reports. Develop complex reporting applications and strategic data solutions tailored to evolving regulatory needs. Undertakes complex assignments requiring additional specialized technical knowledge. Develops very complex and varied strategic report applications from a Data Warehouse. Establishes and communicates common goal and direction for team. Establishes and maintains advanced knowledge of data warehouse database design, data definitions, system capabilities, and data integrity issues. Acts as a source of direction, training and guidance for less experienced staff. Monitors project schedules and costs for own and other projects. Develops and supports very complex Data Warehouse-related applications for business areas requiring design and implementation of database tables. Conducts training on use of applications developed. This job is focused on spending time thinking about programming and how it would be used to design solutions.

Requirements

Requires BA/BS degree in Mathematics, Statistics or related field and a minimum of 7 years experience in broad-based analytical, managed care payor or provider environment as well as in depth experience in statistical analysis and modeling; or any combination of education and experience which would provide an equivalent background.

Nice To Haves

Experience in data analysis, reporting, or related areas, preferably within the healthcare sector is helpful.
Expertise in data management tools, business information applications, and programming/query languages (SQL and/or SAS) is required.
Python/R is highly preferred.
Comprehensive provider-level knowledge, including understanding taxonomy, alternate payment models (e.g., capitation), and value-based care reimbursement systems preferred.
Awareness of quality measures and initiatives designed to improve healthcare outcomes preferred.
Ability to communicate effectively with multiple levels within the organization is strongly preferred.

Responsibilities

Serve as a subject matter expert for regulatory reporting, ensuring that all submissions meet internal and external standards for accuracy and compliance.
Collaborate with various teams to gather and interpret requirements related to health insurance data reporting.
Retrieve, consolidate, and collate data from multiple data warehouses to produce comprehensive reports.
Develop complex reporting applications and strategic data solutions tailored to evolving regulatory needs.
Undertakes complex assignments requiring additional specialized technical knowledge.
Develops very complex and varied strategic report applications from a Data Warehouse.
Establishes and communicates common goal and direction for team.
Establishes and maintains advanced knowledge of data warehouse database design, data definitions, system capabilities, and data integrity issues.
Acts as a source of direction, training and guidance for less experienced staff.
Monitors project schedules and costs for own and other projects.
Develops and supports very complex Data Warehouse-related applications for business areas requiring design and implementation of database tables.
Conducts training on use of applications developed.