Provider Contract, Cost of Care Consultant

Role Overview

• 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
• Works on complex enterprise-wide initiatives and acts as project lead
• Uses analytic tools to track both health risks and compliance
• Performs sophisticated retrospective data analytics
• Builds new and modifies existing complex models to create predictive impact decision making tools
• 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
• Performs modeling to compare various contract scenarios based on member utilization patterns and 'what if' logic
• Researches financial profitability/stability and competitive environment of providers to determine impact of proposed rates
• 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
• Recommends 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

Requirements

• Requires BS/BA degree in Mathematics, Statistics, or related field
• minimum of 5 years of experience in broad-based analytical, managed care payor or provider environment
• considerable experience in statistical analysis and healthcare modeling
• Duals experience highly preferred
• Proficiency in data manipulation tools such as SQL, SAS, or similar highly preferred
• Exceptional analytical, organizational, presentation, and problem-solving skills preferred
• Cost of care analysis knowledge preferred

Tech Stack

• SQL

Benefits

• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs
• medical benefits
• dental benefits
• vision benefits
• short term disability benefits
• long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources