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Provider Contract/Cost of Care Analyst Senior

**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 Columbus, OH, Norfolk, VA, Mason, OH, Atlanta, GA, Wallingford, CT or Indianapolis, IN. 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 Analyst Senior** provides analytical support to the Cost of Care and/or Provider Contracting organizations and serves as an expert in value-based program financial data analysis, reporting and formulating recommendations and providing guidance to other data analysts. Focuses efforts on lowering claims costs, improving the quality of care, increasing member and provider network satisfaction and supporting all value-based provider payments, ensuring accurate/on time payments. Provides advice and analytic support to Medical Directors, contract negotiators and management on cost of care issues to help reduce costs without compromising quality of care.

How you will make an impact:

+ Creates and maintains databases to track business/program financial performance.

+ Develops and analyzes business/program performance reports (e.g. program performance data, program financial data and provides notations of performance deviations and anomalies as it relates to the financial impact of the value-based program.

+ Creates and publishes periodic reports, as well as any necessary ad hoc reports.

+ Manages business issues and devises best way to develop appropriate diagnostic and/or tracking financial data that will translate business requirements into usable decision support tools.

+ Makes recommendations based upon data analysis and financial performance.

+ Provides analytic consultation to other business areas, leadership or external customers.

+ Conducts financial data analysis and reporting encompasses a much higher level of complexity.

+ Supports PIMS (payment management innovation system) maintenance/enhancements for all value based payments ensuring accurate financial reporting.

+ Performs varied data analyses.

+ Develops moderately complex ROI models and 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.

+ Prepares pre-negotiation analyses to support development of defensible pricing strategies.

+ Performs modeling to compare various contract scenarios based on member utilization patterns and 'what if' logic.

+ Measures and evaluates the cost impact of various negotiation proposals.

+ Researches the financial profitability/stability and competitive environment of providers to determine impact of proposed rates.

+ 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.

+ Recommends alternative contract language and may go on-site to provider premises during contract negotiations.

+ Participates on project team involved with enterprise-wide initiatives.

Minimum Requirements:

Requires BS/BA degree in Mathematics, Statistics, or related field and a minimum of 3 years of 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.

Preferred Skills, Capabilities and Experiences:

+ SQL/query skills highly preferred.

+ Strong analysis skills highly preferred.

+ Value based program experience highly preferred.

+ Medicare experience preferred.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $74,080.00.00 to $111,120.00.00

Location(s): Columbus, OH

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company.  The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The 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. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. 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 for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

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 [email protected] for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.