Elevance Health
Financial consultant
Elevance Health, Denver, Colorado, United States, 80285
Provider Contract/Cost of Care Consultant
We are offering a $5,000 sign-on bonus for this position.
Location:
This position will work a hybrid model (remote and in office 1-2 days per week). Candidates must live within 50 miles of one of our Pulse Point locations.
The
Provider Contract/Cost of Care Consultant
will provide 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.
Works on 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.
Can work with multiple provider types, e.g. physician, ancillary, medical groups, or hospitals.
Supports a full range of contract arrangements and pricing mechanisms.
Works on complex enterprise-wide initiatives and acts as project lead.
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.
Building new and modifying existing complex 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 pre-negotiation analysis 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.
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.
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.
Participates on project team involved with enterprise wide initiatives.
Acts as a source of direction, training and guidance for less experienced staff.
Minimum RequirementsRequires BS/BA degree in Mathematics, Statistics, or related field; minimum of 5 years experience in broad-based analytical, managed care payor or provider environment; considerable 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.
Healthcare facility contract/reimbursement experience.
Advanced Microsoft Excel knowledge/experience.
SQL experience.
For candidates working in person or remotely in the below locations, the salary range for this specific position is $81,600 to $146,880.00.
Locations: Colorado; District of Columbia (Washington D.C.); New York; Nevada; Maryland; Washington State.
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
Elevance Health is committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
If this job is assigned to any Government Business Division entity, the applicant and incumbent may be subject to additional requirements beyond those associates outside Government Business Divisions.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes are deemed to be the property of Elevance Health.
Who We AreElevance 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.
How We WorkAt 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.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19.
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.
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We are offering a $5,000 sign-on bonus for this position.
Location:
This position will work a hybrid model (remote and in office 1-2 days per week). Candidates must live within 50 miles of one of our Pulse Point locations.
The
Provider Contract/Cost of Care Consultant
will provide 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.
Works on 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.
Can work with multiple provider types, e.g. physician, ancillary, medical groups, or hospitals.
Supports a full range of contract arrangements and pricing mechanisms.
Works on complex enterprise-wide initiatives and acts as project lead.
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.
Building new and modifying existing complex 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 pre-negotiation analysis 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.
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.
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.
Participates on project team involved with enterprise wide initiatives.
Acts as a source of direction, training and guidance for less experienced staff.
Minimum RequirementsRequires BS/BA degree in Mathematics, Statistics, or related field; minimum of 5 years experience in broad-based analytical, managed care payor or provider environment; considerable 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.
Healthcare facility contract/reimbursement experience.
Advanced Microsoft Excel knowledge/experience.
SQL experience.
For candidates working in person or remotely in the below locations, the salary range for this specific position is $81,600 to $146,880.00.
Locations: Colorado; District of Columbia (Washington D.C.); New York; Nevada; Maryland; Washington State.
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
Elevance Health is committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
If this job is assigned to any Government Business Division entity, the applicant and incumbent may be subject to additional requirements beyond those associates outside Government Business Divisions.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes are deemed to be the property of Elevance Health.
Who We AreElevance 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.
How We WorkAt 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.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19.
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.
#J-18808-Ljbffr