Provider Contract Cost of Care Consultant
Woodland Hills, CA 91364
Primary duties may include, but are not limited to:
* Identifies cost of care savings opportunities by analyzing practice patterns in relation to office visits, referral practices, and specialty care procedures.
* 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.
* Participates on project team involved with enterprise wide initiatives.
* Acts as a source of direction, training and guidance for less experienced staff.
* Requires BS/BA degree in Mathematics, Statistics, or related field.
* minimum of 5 years experience in broad-based analytical, managed care payor or provider environment; considerable experience in statistical analysis and healthcare modeling.
* any combination of education and experience, which would provide an equivalent background.
* SQL required.
* Microsoft Office Excel - Advanced proficiency required.
* SAS preferred.
* Master's degree preferred.