Provider Contract/Cost of Care Consultant Senior

Provider Contract/Cost Of Care Consultant Senior

This role requires associates to be in-office 1 day per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Ideal candidates will be able to report to one of our Pulse Point locations in Atlanta, GA, Indianapolis, IN, Mason, OH or Richmond, VA. Alternate locations may be considered if candidates reside within a commuting distance from an office.

The Provider Contract/Cost Of Care Consultant Senior provides the highest level of analytical support to the Cost Of Care and/or Provider Contracting organizations.

How you will make an impact:

• 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.
• 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 impact of proposed rates and 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 and recommends policy changes and claim's 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.
• Researches provider's financial profitability/stability and competitive environment to determine impact of proposed rates.
• Communicates fee strategies to manage provider expectations.
• Provides on-going analytic and consultative support during complex and the most intense provider negotiations.
• Educates provider contractors on contracting analytics from a financial impact perspective.
• Acts as a source of direction, training and guidance for less experienced staff.

Minimum Requirements:

Requires BA/BS degree in Mathematics, Statistics or related field and a minimum of 7 years of experience in broad-based analytical, managed care payor or provider environment as well as in depth experience in statistical analysis and modeling; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• 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.

Job Level: Non-Management Exempt

Workshift:

Job Family: RDA > Health Economics & Cost of Care