Provider Contract/Cost of Care Consultant Senior at Elevance Health

Atlanta, Georgia, United States

Apply Now

Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

BA/BS degree in Mathematics (or related field, as description cuts off)
Ability to report to Pulse Point locations in Atlanta, GA, Indianapolis, IN, Mason, OH, or Richmond, VA (in-office 1 day per week; candidates not within reasonable commuting distance not considered unless accommodation granted)

Responsibilities

Provides the highest level of analytical support to 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 health risks, compliance, and support 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 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' analysis
Researches financial profitability/stability and competitive environment of providers to determine impact of proposed rates and projects cost savings targets based on analytics
Identifies cost of care savings opportunities by analyzing practice patterns (office visits, referrals, specialty procedures) and recommends policy changes and claims system changes
Reviews post-implementation results to ensure projected savings are realized and recommends modifications
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 negotiations
Communicates fee strategies to manage provider expectations
Provides ongoing analytic and consultative support during complex provider negotiations
Acts as a source of direction, training, and guidance for less experienced staff

Skills

Provider Contracting

Cost of Care Analysis

Contract Negotiation

Analytics

Data Analysis

Project Leadership

Strategic Consulting

Claims Cost Reduction

Quality of Care Improvement

Health Risk Tracking

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.

Land your dream remote job 3x faster with AI

Try Jobo Free