Provider Contract / Cost of Care Consultant (US)

Provider Contract / Cost Of Care Consultant

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 Indianapolis, IN, Norfolk, VA, Atlanta, GA, Nashville, TN, St. Louis, MO or Louisville, KY. 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 Provider Contracting, Product and Solutions 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. Works on large scale initiatives with high dollar cost savings opportunities. Partners with provider contractors to develop contracting strategy and supports all aspects of the contract negotiation process. Works with multiple post-acute care provider types, e.g., home health, skilled nursing facility. 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 :

• Uses analytic tools to track both health risks and compliance, as well as supporting the contract negotiation process.
• Builds and maintains Tableau dashboards from multiple data sources to allow multiple departments access to network performance views.
• Creates logic for reporting from databases such as SQL and other data warehouse sites.
• Types of analyses include performing sophisticated retrospective data analytics; building new and modifying existing complex 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 via multiple variable analysis; preparing pre-negotiation analysis 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; 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 referral patterns in relation to post-acute care, referral practices, and specialty care procedures.
• Recommends policy changes and claim's system changes to pursue cost savings.
• Reviews result 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.
• Recommends alternative contract language and may participate in virtual meetings with provider 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 :

Preferred Skills, Capabilities And Experiences :