Provider Contract/Cost of Care Consultant

Provider Contract/Cost of Care Consultant

Provider Contract/Cost of Care Consultant

Location: This role requires associates to be in-office 1-2 days 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. 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.

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, and 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 a contracting strategy and support all aspects of the contract negotiation process. Can work with multiple provider types, e.g. physicians, ancillary, medical groups, or hospitals. Supports a full range of contract arrangements and pricing mechanisms. Works on complex enterprise-wide initiatives and acts as project lead.

How you will make an impact:

• Creates and maintains databases to track business performance.
• Analyzes data and summarizes performance using summary statistical procedures.
• Develops and analyzes business performance reports (e.g. for revenue, claims, provider, member, and utilization data) and provides notations of performance deviations and anomalies.
• Creates and publishes periodic reports, as well as any necessary ad hoc reports.
• May require taking business issues and devising the best way to develop appropriate diagnostic and/or tracking data that will translate business requirements into usable decision support tools.
• May make recommendations based on data analysis.
• Programs and writes queries and reports.
• Conducts training on the use of applications developed.
• Work with internal and external customers to solve business problems.

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:

• Must have experience with Medicare & Commercial Lines of Business.
• Experience with relational databases and knowledge of query tools.
• Ability to manipulate large sets of data.
• Strong analytical, organizational, and problem-solving skills are strongly preferred.
• Experience in SQL, SAS, Teradata, and relational databases is highly desired.
• MS Office Suite of tools desired. Advanced Excel experience preferred.
• Tableau, Business Objects, or other reporting tools preferred.
• Strong analytical, organizational, and problem-solving skills are highly preferred.
• Good client-facing skills.
• Exposure to Python and R preferred.

Job Level: Non-Management Exempt