Hybrid Senior Provider Contract/Cost of Care Consultant

at Elevance Health

• Job title: Senior Provider Contract/Cost of Care Consultant
• Job type: Full Time
• Experience level: Senior
• Salary: Not specified
• Degree requirement: Bachelor's Degree
• Tech skills: SQL
• Location requirements: Hybrid, Atlanta, United States

About the role

• Provider Contract/Cost of Care Consultant Senior supporting cost savings initiatives in healthcare at Elevance Health. Providing analytical support to improve quality of care and network satisfaction.

Responsibilities

• Provides the highest level of analytical support to the Cost of Care and/or Provider Contracting organizations
• Focuses efforts on lowering claims costs, improving 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
• Leads 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
• Works with multiple provider types including the most complex, high-profile providers
• Supports a full range of contract arrangements and pricing mechanisms including the most complex contract terms
• Works on the most complex, large scale enterprise-wide initiatives and acts as project lead
• Acts as a strategic partner to management
• Uses analytic tools to track both health risks and compliance, as well as supporting the contract negotiation process
• Performs sophisticated retrospective data analytics
• Develops the most complex new models and modifies existing 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 complex 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'
• Researches the financial profitability/stability and competitive environment of providers to determine the impact of proposed rates
• Recommends modifications as applicable
• Recommends standardized practices to optimize cost of care
• Educates provider contractors on contracting analytics from a financial impact perspective
• Communicates fee strategies to manage provider expectations
• Provides on-going analytic and consultative support during complex negotiations
• Acts as a source of direction, training and guidance for less experienced staff.

Requirements

• Requires BA/BS degree in Mathematics, Statistics or related field
• Minimum of 7 years of experience in broad-based analytical, managed care payor or provider environment
• In depth experience in statistical analysis and modeling
• Master's degree preferred
• Experience providing leadership in evaluating and analyzing complex initiatives preferred
• Cost of care analysis knowledge preferred
• Proficiency in data manipulation tools such as SQL, SAS, or similar preferred
• Exceptional analytical, organizational, presentation, and problem-solving skills preferred
• Provider contract knowledge preferred
• Medicare Group Retiree experience preferred.

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