Provider Contract Data Consultant Sr

Provider Contract Data Consultant Sr

Provides the highest level of analytical support to the Cost of Care and/or Provider Contracting organizations. 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. 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 both health risks and compliance, as well as supporting the contract negotiation process. Types of analyses include performing sophisticated retrospective data analytics; developing the most complex new models and modifies existing models to create predictive impact decision making tools; performing healthcare cost analysis to identify strategies to control costs; projecting cost increases in medical services by using analytic techniques for PMPM trending via multiple variable analysis; preparing complex pre-negotiation analyses to support development of defensible pricing strategies; performing modeling to compare various contract scenarios based on member utilization patterns and 'what if'; measuring and evaluating the cost impact of various negotiation; researching 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.

May recommend 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.

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.

Required Qualifications:

• Requires BA/BS degree in Mathematics, Statistics or related field and a minimum of 7 years 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 Qualifications:

• Experience providing leadership in evaluating and analyzing complex initiatives strongly preferred
• Government Business Experience strongly preferred
• HEDIS/STARS experience preferred
• Ability to Develop/code in SQL preferred
• SAS/Python Experience preferred
• Data Analysis experience is a must
• Value Based care experience nice to have

Job Level: Non-Management Exempt

Workshift: 1st Shift (United States of America)

Job Family: RDA > Health Economics & Cost of Care

Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.