The Cost of Care and/or Provider Analyst Senior 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 through analytical and strategic support of value-based contracts. Provides advice and analytic support to Medical Directors, contract negotiators, and management, and provider group leadership on cost of care issues to help reduce costs without compromising quality of care.
Location – Remote Nationwide Preference to EST/CST Time Zones
Primary duties may include, but are not limited to:
• Developing moderately complex ROI models and performs healthcare cost analysis to identify strategies to control costs; projecting cost increases in medical services by using analytic techniques for PMPM trending via multiple variable analysis; preparing pre-negotiation analyses to support development of defensible pricing strategies; performing modeling to compare various contract scenarios based on member utilization patterns and 'what if' logic; measuring and evaluating the cost impact of various negotiation proposals; researching the financial profitability/stability and competitive environment of providers to determine impact of proposed rates; and projecting 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 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.
• May recommend 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 Business, Analytics, 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
Or any combination of education and experience which would provide an equivalent background.
• Master's Degree
• Experience with Medicaid and/or Medicare.
• Experience with value-based contracts.
• Excellent analytical, organizational, planning, and oral and written communication skills.
Applicable to Colorado Applicants Only
Annual Salary Range*: $70,160 - $87,700
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
* The hourly or 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. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance.