Provider Contract Data Consultant Sr at Elevance Health

Mason, Ohio, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

BA/BS degree in Mathematics, Statistics or related field
Minimum of 7 years experience in broad-based analytical, managed care payor or related field

Responsibilities

Provides the highest level of analytical support to the Cost of Care and/or Provider Contracting organizations, focusing 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
Supports 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 and compliance, and support 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 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' scenarios
Measures and evaluates the cost impact of various negotiations
Researches the financial profitability/stability and competitive environment of providers to determine impact of proposed rates
Projects different cost 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
May recommend alternative contract language and may go on-site to provider premises during contract negotiations
Provides on-going analytic and consultative support during complex and the most intense provider negotiations
Acts as a source of direction, training and guidance for less experienced staff
Looks for continuous quality improvements and finds better ways to accomplish end results
Works side by side with their program manager

Skills

Key technologies and capabilities for this role

data analyticshealthcare cost analysiscontract negotiationpredictive modelingretrospective analysisSQLExcelprovider contractingrisk analysiscompliance tracking

Questions & Answers

Common questions about this position

What is the work arrangement for this role?

This role requires associates to be in-office 1-2 days per week to foster collaboration, while providing flexibility for virtual work the rest of the time. Alternate locations may be considered if candidates reside within commuting distance from an office.

What are the office locations for this position?

The position is based in Mason OH, Tampa FL, Richmond VA, Atlanta GA, Grand Prairie TX, or Indianapolis IN.

What skills are required for this role?

The role requires advanced analytical skills, including sophisticated retrospective data analytics, developing complex predictive models, healthcare cost analysis, PMPM trending via multiple variable analysis, and contract scenario modeling.

What is the salary or compensation for this position?

This information is not specified in the job description.

What experience makes a strong candidate for this role?

Strong candidates have experience with the most complex large-scale enterprise initiatives, acting as project lead, partnering on contracting strategy, supporting high-profile provider negotiations, and providing expert analytic support on cost of care issues.

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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