Senior Provider Contract Analyst

5 days ago


Marquand, Missouri, United States Elevance Health Full time
About the Role

We are seeking a highly skilled Senior Provider Contract Analyst to join our team at Elevance Health. As a key member of our Cost of Care and Provider Contracting organizations, you will play a critical role in providing analytical support to drive business growth and improve member and provider network satisfaction.

Key Responsibilities
  • Perform complex data analyses to identify strategies to control costs and improve quality of care.
  • Develop and implement ROI models to project cost increases in medical services.
  • Prepare pre-negotiation analyses to support development of defensible pricing strategies.
  • Model various contract scenarios based on member utilization patterns and 'what if' logic.
  • Measure and evaluate the cost impact of negotiation proposals.
  • Research the financial profitability and competitive environment of providers to determine the impact of proposed rates.
  • Identify cost of care savings opportunities by analyzing practice patterns and recommend policy changes and claim's system changes to pursue cost savings.
  • Review results post-implementation to ensure projected cost savings are realized and recommend modifications as applicable.
  • Recommend standardized practices to optimize cost of care.
  • Educate provider contractors on contracting analytics from a financial impact perspective.
  • May recommend alternative contract language and participate in on-site contract negotiations.
Requirements
  • Requires a 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.
Preferred Skills and Experiences
  • Master's degree preferred.
  • Proficiency in 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.
Work Environment

This is a hybrid role that requires working at an Elevance Health location at least once per week. The ideal candidate will live within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

About Elevance Health

Elevance Health is a health company dedicated to improving lives and communities. 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.



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