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Provider Contractor/Cost of Care Consultant

at Elevance Health in CHICAGO, Illinois, United States

Job Description

Provider Contract/Cost of Care Consultant

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. Ideally located in: Mason, OH; Indianapolis, IN; Louisville, KY; Columbus, OH; Norfolk, VA; Richmond, VA; St. Louis, MO; Atlanta, GA; Columbus, GA; Chicago, IL.

The Provider Contract/Cost of Care Consultant provides 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. 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. Works on complex enterprise-wide initiatives and acts as project lead.

How you will make an impact:

+ 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.

+ Performing modeling to compare annual chargemaster increases.

+ Measuring and evaluating the cost impact of various negotiation.

+ Researching the financial profitability/stability and competitive environment of providers to as it relates to the chargemaster changes.

+ Projects different cost of savings targets based upon various analytics.

+ Identifies cost of care savings opportunities by analyzing charging practices in relation to business volume.

+ 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 requirements:

Requires 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 preferred.

+ Experience reviewing and analyzing Ambulatory Surgical Centers’ (ASC) year-over-year changes in Chargemaster (CDM) increases, preferred.

+ Experience conducting audits to ensure compliance with agreed-upon rate increases, preferred.

+ Experience reviewing and analyzing yearly charge increases among professional services, preferred.

+ Experience conducting audits to ensure compliance with agreed-upon rate increases, preferred.

+ Experience conducting audits comparing reported procedure code charges to local and national averages, preferred.

+ Experience investigating significant discrepancies, documenting findings and making recommendations, preferred.

+ Experience validating data and findings from CDM audits, preferred.

+ Experience repricing provider submitted data and ensuring compliance with agree-upon increases, preferred.

+ Experience reviewing and analyzing hospital facilities year-over-year changes in Chargemaster (CDM) increases, preferred.

+ Experience conducting audits to ensure compliance with agreed-upon rate increases, preferred.

+ Experience with SAS Programming preferred.

+ Ability to collaborate with audit teams, understanding requirements, preferred.

+ Experience with Microsoft Access programming, preferred.

+ Ability to design, modify, and optimize Access databases to enhance audit processes and outcomes, preferred.

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Job Posting: JC260841568

Posted On: Jun 06, 2024

Updated On: Jun 22, 2024

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