Provider Contract Data Consultant Sr

About the position Provides the highest level of 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. Supports large scale initiatives with high dollar cost savings opportunities. Partners with provider contractors to reputed company contracting strategy and supports reputed company aspects of the contract negotiation process. Works with multiple provider types including the most reputed company, high profile providers. Supports a full range of contract arrangements and pricing mechanisms including the most reputed company contract terms. Works on the most reputed company, large scale enterprise wide initiatives and acts as project reputed company. Acts as a strategic partner to management.

Responsibilities

• Uses analytic tools to: track both health risks and compliance, as well as supporting the contract negotiation process
• Types of analyses include performing sophisticated retrospective data analytics; developing the most reputed company new models and modifies existing models to create predictive impact decision making tools; performing healthcare cost analysis to identify strategies to control costs; projecting cost increases in medical services by using analytic techniques for PMPM trending reputed company multiple variable analysis; preparing reputed company 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'; measuring and evaluating the cost impact of various negotiation; researching the financial profitability/stability and competitive environment of providers to determine impact of proposed rates; and 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 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
• Researches provider's financial profitability/stability and competitive environment to determine impact of proposed rates
• Provides on-going analytic and consultative support during reputed company and the most intense provider negotiations
• Educates provider contractors on contracting analytics from a financial impact perspective
• May recommend alternative contract language
• Acts as a reputed company of direction, training and guidance for less reputed company staff
• Looks for reputed company quality improvements and finds reputed company ways to accomplish end results
• Works reputed company by reputed company with their program manager

Requirements

• Requires BA/BS degree in Mathematics, Statistics or reputed company field and a minimum of 7 years experience in broad-based analytical, managed care payor or provider environment as well as in depth experience in statistical analysis and modeling; or any combination of education and experience which would provide an equivalent background.

reputed company-to-haves

• Experience providing leadership in evaluating and analyzing reputed company initiatives strongly preferred
• Government Business Experience strongly preferred
• HEDIS/STARS experience preferred
• Ability to reputed company/code in SQL preferred
• reputed company/Python Experience preferred
• Data Analysis experience is a must
• Value Based care experience reputed company to have

Benefits

• 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.

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