Provider Contract/Cost of Care Consultant

Provider Contract/Cost Of Care Consultant

Location: 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 Atlanta, GA, Indianapolis, IN, Mason, OH or Richmond, VA. Alternate locations may be considered if candidates reside within a commuting distance from an office.

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.

How You Will Make An Impact:

• 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 with multiple provider types, e.g. physician, ancillary, medical groups, or hospitals.
• Works on complex enterprise-wide initiatives and acts as project lead.
• Uses analytic tools to track both health risks and compliance, as well as supporting the contract negotiation process.
• Performs sophisticated retrospective data analytics.
• Builds new and modifying 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 scenarios based on member utilization patterns and 'what if' logic.
• Measures and evaluates the cost impact of various negotiation.
• Develop financial savings and ROI models using CoC governance guidelines.
• 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 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 accountable function 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.

Minimum 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; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences: Master's degree preferred.

Job Level: Non-Management Exempt

Workshift: 1st Shift (United States of America)

Job Family: RDA > Health Economics & Cost of Care