Provider Contract ConsultantLocation: 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
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 AreElevance 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 WorkAt 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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.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. 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 elevancehealthjobssupport@elevancehealth.com for assistance.
