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
