Provider Contract Consultant

Elevance Health • Woodland Hills, CA

3d • Hybrid

About The Position

The Provider Contract Consultant creates and manages contract templates used across the enterprise to ensure consistency and compliance with all legislative and regulatory requirements.

Requirements

• Requires a BA/BS degree in a related field and a minimum of 3 years related experience with contract language, contract development, negotiation, and/or administration; or any combination of education and experience, which would provide an equivalent background.

Responsibilities

• Supports/assists Network Directors/Managers with CA ASC Network renewals and recruitment.
• Acts as a liaison between Network Directors/Managers internal supporting departments PE, HE, CCU, etc. and externally.
• Provides contract support, documentation assistance and review on all product lines (Commercial, Medicare, Medicaid).
• Supports COC initiatives and leads project work impacting business unit.
• Facilitates follow up with PE/PIR/ Special Projects Teams on provider issues
• Creates common contract templates for various provider groups to be used throughout the enterprise.
• Works closely with Legal and provider contracting management to ensure that contracts meet all federal, state and regulatory requirements.
• Recommends language changes and use of alternative or exception language approved for specific uses.
• Reviews contract language in response to RFPs, audits, and legal clarifications.
• Makes recommendations to contract modifications and presents to governing committee for approval.
• Works with contract negotiators to identify areas where push-back is appropriate and helps to educate contract negotiators on contract language impacts.
• Review contracts to ensure that contract terms and language can be implemented appropriately.
• Researches and quantifies impact to contract modifications.
• Maintains tracking software to assist in reporting and responding to key leadership, providers, and consumers.
• Develops tools to assist contract negotiators in negotiating effective contracts.

Benefits

• comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level