Provider Contract/Cost of Care Consultant

Elevance Health • Indianapolis, IN

76d

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. 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. Partners with provider contractors to develop contracting strategy and supports all aspects of the contract negotiation process. Supports a full range of contract arrangements and pricing mechanisms. Works on complex enterprise-wide initiatives and acts as project lead.

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.

Nice To Haves

• Cost of care analysis knowledge highly preferred.
• Proficiency in data manipulation tools such as SQL, SAS, or similar highly preferred.
• Exceptional analytical, organizational, presentation, and problem-solving skills preferred.
• Provider contract knowledge preferred.
• Medicare Group Retiree experience preferred.

Responsibilities

• 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 modifies 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.
• Prepares pre-negotiation analysis 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.
• 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.
• Recommends policy changes and claims 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.
• 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 benefits
• Short and long term disability benefits
• 401(k) + match
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources

What This Job Offers

• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees