Provider Contract Consultant
Elevance Health

Provider Contract Consultant

Location: This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations in Kansas.

The Provider Contract Consultant creates and manages contract templates used across the enterprise to ensure consistency and compliance with all legislative and regulatory requirements. This position will be supporting our new Kansas Medicaid health plan. The role will focus on Value-Based Contracts, Provider Contract Analysis and fee schedule / reimbursement methodology analysis.

How you will make an impact:

• Creates common contract templates for various provider groups to be used throughout the enterprise
• Works closely with Legal and provider contracting management to ensure that contracts meet all federal, state and regulatory requirements
• Recommends language changes and use of alternative or exception language approved for specific uses
• Reviews contract language in response to RFPs, audits, and legal clarifications
• Makes recommendations to contract modifications and presents to governing committee for approval
• Works with contract negotiators to identify areas where push-back is appropriate and helps to educate contract negotiators on contract language impacts
• Review contracts to ensure that contract terms and language can be implemented appropriately
• Researches and quantifies impact to contract modifications
• Maintains tracking software to assist in reporting and responding to key leadership, providers, and consumers
• Develops tools to assist contract negotiators in negotiating effective contracts

Minimum Requirements:

Requires a BA/BS degree in a related field and a minimum of 3 years related experience with contract language, contract development, negotiation, and/or administration; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• Master's degree, preferred
• Knowledge of hospital and physician reimbursement methodologies, Medicaid Managed Care, and Value-Based Contracts in particular full risk capitation arrangements and capitation analytics
• Strong analytical, organizational and problem-solving skills, strongly preferred
• Excellent communication skills, written and verbal, and experience working closely with clients to interpret business requirements/deliverables
• Experience in SQL, SAS, Teradata, and relational databases, highly desired
• MS Office Suite of tools desired, advanced Excel experience, preferred
• Tableau, Business Objects, or other reporting tools, preferred
• Exposure to Python and R, preferred
• Ability to manipulate large sets of data

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