Provider Contract Cost of Care Analyst Senior at Elevance Health

Atlanta, Georgia, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

BS/BA degree in Mathematics, Statistics, or related field
Minimum of 3 years experience in broad-based analytical, managed care payor or provider environment
Experience in statistical analysis and healthcare modeling (or any combination of education and experience providing equivalent background)

Responsibilities

Develop moderately complex ROI models and perform healthcare cost analysis to identify strategies to control costs
Project cost increases in medical services using analytic techniques for PMPM trending via multiple variable analysis
Prepare pre-negotiation analyses to support development of defensible pricing strategies
Perform modeling to compare various contract scenarios based on member utilization patterns and 'what if' logic
Measure and evaluate the cost impact of various negotiation proposals
Research the financial profitability/stability and competitive environment of providers to determine impact of proposed rates and project different cost savings targets based upon various analytics
Identify cost of care savings opportunities by analyzing practice patterns in relation to office visits, referral practices, and specialty care procedures
Recommend policy changes and claims system changes to pursue cost savings
Review results post-implementation to ensure projected cost savings are realized and recommend modifications as applicable
Recommend standardized practices to optimize cost of care
Educate provider contractors on contracting analytics from a financial impact perspective
Recommend alternative contract language and may go on-site to provider premises during contract negotiations
Participate on project teams involved with enterprise-wide initiatives

Skills

ROI modeling

healthcare cost analysis

PMPM trending

multiple variable analysis

contract modeling

utilization analysis

what-if analysis

financial profitability analysis

SQL

Excel

healthcare analytics

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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