Provider Contract​/Cost of Care Analyst Senior

Anticipated End Date:

Position Title:

Provider Contract/Cost of Care Analyst Senior

Provider Contract/Cost of Care Analyst Senior

This role requires associates to be in-office 1 day per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Ideal candidates will be able to report to one of our Pulse Point locations in Columbus, OH, Norfolk, VA, Mason, OH, Atlanta, GA, Wallingford, CT or Indianapolis, IN.

Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

• Creates and maintains databases to track business/program financial performance.
• Develops and analyzes business/program performance reports (e.g. program performance data, program financial data and provides notations of performance deviations and anomalies as it relates to the financial impact of the value-based program.
• Creates and publishes periodic reports, as well as any necessary ad hoc reports.
• Manages business issues and devises best way to develop appropriate diagnostic and/or tracking financial data that will translate business requirements into usable decision support tools.
• Makes recommendations based upon data analysis and financial performance.
• Provides analytic consultation to other business areas, leadership or external customers.
• Conducts financial data analysis and reporting encompasses a much higher level of complexity.
• Supports PIMS (payment management innovation system) maintenance/enhancements for all value based payments ensuring accurate financial reporting.
• Performs varied data analyses.
• Develops moderately complex ROI models and performs healthcare cost analysis to identify strategies to control costs.
• Projects cost increases in medical services by using analytic techniques for PMPM trending via multiple variable analysis.
• Prepares pre-negotiation analyses to support development of defensible pricing strategies.
• Performs modeling to compare various contract scenarios based on member utilization patterns and 'what if' logic.
• Measures and evaluates the cost impact of various negotiation proposals.
• Researches the financial profitability/stability and competitive environment of providers to determine impact of proposed rates.
• 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.
• Recommends 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 of 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.

• SQL/query skills highly preferred.
• Strong analysis skills highly preferred.
• Value based program experience highly preferred.
• Medicare experience preferred.

For candidates working in person or virtually in the below location(s), the salary
* range for this specific position is $74,080.00 to $

Location(s):
Columbus, OH

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.

* 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…