Provider Contract/Cost of Care Analyst Senior
About The Position
Provider Contract/Cost of Care Analyst Senior Location: This role requires associates to be in-office 1 day 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. Ideal candidates will be able to report to one of our Pulse Point locations in Columbus, OH, Norfolk, VA, Mason, OH, Atlanta, GA, Wallingford, CT or Indianapolis, IN. 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/Cost of Care Analyst Senior provides analytical support to the Cost of Care and/or Provider Contracting organizations and serves as an expert in value-based program financial data analysis, reporting and formulating recommendations and providing guidance to other data analysts. Focuses efforts on lowering claims costs, improving the quality of care, increasing member and provider network satisfaction and supporting all value-based provider payments, ensuring accurate/on time payments. 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: Creates and maintains databases to track business/program financial performance. Develops and analyzes business/program performance reports (e.g. program performance data, program financial data and provides notations of performance deviations and anomalies as it relates to the financial impact of the value-based program. Creates and publishes periodic reports, as well as any necessary ad hoc reports. Manages business issues and devises best way to develop appropriate diagnostic and/or tracking financial data that will translate business requirements into usable decision support tools. Makes recommendations based upon data analysis and financial performance. Provides analytic consultation to other business areas, leadership or external customers. Conducts financial data analysis and reporting encompasses a much higher level of complexity. Supports PIMS (payment management innovation system) maintenance/enhancements for all value based payments ensuring accurate financial reporting. Performs varied data 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. 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. Recommends 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 of 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
- SQL/query skills highly preferred.
- Strong analysis skills highly preferred.
- Value based program experience highly preferred.
- Medicare experience preferred.
Responsibilities
- Creates and maintains databases to track business/program financial performance.
- Develops and analyzes business/program performance reports (e.g. program performance data, program financial data and provides notations of performance deviations and anomalies as it relates to the financial impact of the value-based program.
- Creates and publishes periodic reports, as well as any necessary ad hoc reports.
- Manages business issues and devises best way to develop appropriate diagnostic and/or tracking financial data that will translate business requirements into usable decision support tools.
- Makes recommendations based upon data analysis and financial performance.
- Provides analytic consultation to other business areas, leadership or external customers.
- Conducts financial data analysis and reporting encompasses a much higher level of complexity.
- Supports PIMS (payment management innovation system) maintenance/enhancements for all value based payments ensuring accurate financial reporting.
- Performs varied data 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.
- 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.
- Recommends alternative contract language and may go on-site to provider premises during contract negotiations.
- Participates on project team involved with enterprise-wide initiatives.
Benefits
- 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).
- merit increases
- paid holidays
- Paid Time Off
- 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
- financial education resources
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
5,001-10,000 employees
