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Provider Contract Consultant (US)

Location:

  • CA, Costa Mesa

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Description

Title:  Provider Contract Consultant 


Location: Costa Mesa, CA | candidate required to reside in posted state | Hybrid position

Build the Possibilities. Make an extraordinary impact. 

The Provider Contract Consultant creates and manages contract templates used across the enterprise to ensure consistency and compliance with all legislative and regulatory requirements. Typically works with Free-standing Ambulatory Surgery Center facilities as well as the Peripheral networks.

How you will make an impact:
•    Creates common contract templates for all lines of business Commercial and Government business Medicare Advantage, Medicaid/Medi-Cal for various provider groups to be used throughout the enterprise, which may require customization fee schedule on an as needed basis. 
•    Works closely with Legal and provider contracting management to ensure that contracts meet all federal, state and regulatory requirements. 
•    Recommends language changes and use of alternative or exception language approved for specific uses. 
•    Reviews contract language in response to RFPs, audits, and legal clarifications.  
•    Require strong analytical thinking skillset to analyze financial reports for Cost of Care.  
•     Must have the ability to work independently and requires critical thinking to troubleshoot issues as they arise, detailed oriented, high level of judgement and discretion when working with providers, working negotiations and on projects impacting the business unit requiring collaboration with other key areas or serve on enterprise projects around network management.  
•    Ability to be creative and think outside of the box.  

•    Makes recommendations to contract modifications and presents to governing committee for approval. 
•    Works with contract negotiators to identify areas where push-back is appropriate and helps to educate contract negotiators on contract language impacts. 
•    Review contracts to ensure that contract terms and language can be implemented appropriately. 
•    Researches and quantifies impact to contract modifications. Maintains tracking software to assist in reporting and responding to key leadership, providers, and consumers. 
•    Develops tools to assist contract negotiators in negotiating effective contracts. 

Minimum Requirements:
•    Requires a BA/BS degree in a related field and a minimum of 3 years related experience with contract language, contract development, negotiation, analyzing data and financial reports and/or administration; or any combination of education and experience, which would provide an equivalent background.
 

Preferred skills, capabilities and experiences: 
•    Must be detailed oriented 
•    Must have analytical and critical thinking abilities 
•    Must be able to work independently and think outside of the box

•    Financial reporting experience preferred
•    Proficient on Microsoft Excel strongly preferred 
 


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 ability@icareerhelp.com for assistance.

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