Provider Contract/Cost of Care Consultant

Elevance Health • Richmond, VA

10h • Hybrid

About The Position

The Provider Contract/Cost of Care Consultant 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.

Requirements

• Requires BS/BA degree in Mathematics, Statistics, or related field
• minimum of 5 years of experience in broad-based analytical, managed care payor or provider environment
• considerable experience in statistical analysis and healthcare modeling
• any combination of education and experience, which would provide an equivalent background

Nice To Haves

• Master's degree 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.
• Works with multiple provider types, e.g. physician, ancillary, medical groups, or hospitals.
• 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.
• Performs sophisticated retrospective data analytics.
• Builds new and modifying existing complex models to create predictive impact decision making tools.
• 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.
• Performs modeling to compare various scenarios based on member utilization patterns and 'what if' logic.
• Measures and evaluates the cost impact of various negotiation.
• Develop financial savings and ROI models using CoC governance guidelines.
• 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.
• 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 accountable function 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.
• Acts as a source of direction, training and guidance for less experienced staff.

Benefits

• 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