Cost of Care Analyst Senior

Cost of Care Analyst Senior

Requirements

• Requires BS/BA degree in Mathematics, Statistics, or related field
• Minimum of 3 years’ experience in broad-based analytical, managed care payor or provider environment
• Experience in statistical analysis and healthcare modeling
• Any combination of education and experience which would provide an equivalent background.

Responsibilities

• Performs varied data analyses which may include developing moderately complex ROI models and performing healthcare cost analysis to identify strategies to control costs.
• Projects cost increases in medical services by using analytic techniques for PMPM trending via multiple variable analysis.
• Prepares pre-negotiation analyses to support development of defensible pricing strategies.
• Performs modeling to compare various contract scenarios based on member utilization patterns and ‘what if’ logic.
• Measures and evaluates the cost impact of various negotiation proposals.
• Researches the financial profitability/stability and competitive environment of providers to determine impact of proposed rates.
• 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.
• Recommends alternative contract language and may go on-site to provider premises during contract negotiations.
• Participates on project team involved with enterprise-wide initiatives.

Preferred Qualifications

• Snowflake and SQL experience highly preferred.
• Master’s degree preferred.