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Provider Contract Cost of Care Consultant

Woodland Hills, CA 91364

Posted: 09/06/2018 Industry: IT Job Number: JN -042018-109090
Provides 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. 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 on complex enterprise-wide initiatives and acts as project lead.

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.

Requirements:

* 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.

Qualifications:

* SQL required.
* Microsoft Office Excel - Advanced proficiency required.
* SAS preferred.
* Master's degree preferred.

Annie Hollon

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