- 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.
- 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.
- 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.
- Master's degree preferred.
- The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
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Provider Contract Cost of Care Analyst - Woodland Hills, United States - Elevance Health
Description
Provider Contract Cost of Care Analyst
Location: 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.
Preferred Location: Columbia, MO.
The Provider Contract Cost of Care Analyst is responsible for providing analytical support to the Cost of Care and/or Provider Contracting organizations.
How you will make an impact:
Minimum Requirements:
Preferred Skills, Capabilities, and Experiences:
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $71,920 to $129,456.
Locations : California
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). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully 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.
