Provider Contract Data Consultant Sr

Anticipated End Date:

2025-11-21

Position Title:

Provider Contract Data Consultant Sr

Job Description:

Locations: Mason OH, Tampa FL, Richmond VA, Atlanta GA, Grand Prairie TX, Indianapolis IN

Hours: Monday - Friday

Travel: This role requires associates to be in-office 1 - 2 days 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. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Position Overview:

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 develop contracting strategy and supports all aspects of the contract negotiation process. Works with multiple provider types including the most complex, high profile providers. Supports a full range of contract arrangements and pricing mechanisms including the most complex contract terms. Works on the most complex, large scale enterprise wide initiatives and acts as project lead. Acts as a strategic partner to management.
 

How You Will Make an Impact:

• 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 complex 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 via multiple variable analysis; preparing complex 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 complex 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 source of direction, training and guidance for less experienced staff

• Looks for continuous quality improvements and finds better ways to accomplish end results

• Works side by side with their program manager

Required Qualifications:

• Requires BA/BS degree in Mathematics, Statistics or related 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.

Preferred Qualifications:

• Experience providing leadership in evaluating and analyzing complex initiatives strongly preferred

• Government Business Experience strongly preferred

• HEDIS/STARS experience preferred

• Ability to Develop/code in SQL preferred

• SAS/Pytho