Provider Contract Analyst SeniorLocation: This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. Ideally located in: Atlanta, GA; Richmond, VA; Indianapolis, IN; Chicago, IL; Mason, OH; St. Louis, MO, Grand Prairie, TX, Iselin, NJ.The Provider Contract Analyst Senior is responsible for providing 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. Typically works with one provider type, e.g. physician, ancillary, or medical group. Provides advice and analytic support to Medical Directors, contract negotiators and management on cost of care issues to help reduce costs without compromising quality of care.How you will make an impact:
Performs varied data analyses which may include developing moderately complex ROI models and performs 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 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' logic.
Measuring and evaluating the cost impact of various negotiation proposals.
Researching the financial profitability/stability and competitive environment of providers to determine impact of proposed rates; and projecting 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.
Participates on project team involved with enterprise – wide initiatives.
Minimum requirements:
Requires BS/BA degree in Mathematics, Statistics, or related field and a minimum of 3 years experience in broad-based analytical, managed care payor or provider environment as well as experience in statistical analysis and healthcare modeling; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
Master's degree preferred.
Proficiency within SQL, SAS, Excel, or equivalent.
Proficiency in analyzing Medicaid claims data.
Experience analyzing and building valued based care contracts for the Medicaid line of business.
Experience reconciling value based care contracts to ensure data accuracy.
Experience working with claims and provider contracts for the Medicaid line of business.