Provider Network Analyst Lead

Provider Network Analyst Lead

Location: This position will work a hybrid model (remote and in office 1 - 2 days per week). Ideal candidates will live or be willing to relocate to within 50 miles of one of our Pulse Point locations in Indianapolis, IN, Norfolk, VA, Atlanta, GA, Mendota Heights, MN, Nashville, TN, St. Louis, MO and Louisville, KY.

The Provider Network Analyst Lead reviews and strategizes between data, creates models, and reporting spreadsheets to help aid the network team as well as other Carelon teams.

How you will make an impact:

• Collaborates and coordinates with provider contractors, network leadership, product development, client services, and actuarial services.

• Manages large data sets, including claims and UM data for state by state and national provider development activities.

• Develops reports, strategies and plans for internal and external provider communications.

• Analyzes provider data sets in order to delivery summarized information, trend reports and useful graphs that impact the provider network development strategies.

• Utilizes data sets and adequacy software such as Quest to identify network adequacy gaps and access deficiencies and recommends contracting targeted providers to close gaps.

• Participates in the rate setting and rate negotiation discussions to drive market based favorable contracts which may include fee for service and capitation rates.

• Analyzes provider utilization data and recommends strategies to remove poor performers from the networks.

• Manages weekly market expansion reports to highlight progress, provider stats and key performance indicators (KPI) metrics.

• Provides contractor negotiation support including collaboration on proposals and generating recommendations to leadership.

• Maintains a comprehensive rate model tool used by contractors that allows them to self-manage the financial impact of incoming rate proposals from providers.

• Manages the provider scorecard to measure performance of providers based on KPIs.

• Creates network adequacy reports to evaluate number of providers by county.

• Creates fee schedule report to track rates paid to providers based on Medicare guidelines.

• Creates client reports on provider networks and may present some of those reports and graphs during client meetings.

Minimum Requirements:

Requires a BA/BS degree and a minimum of 8 years’ experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• Healthcare experience strongly preferred.

• Experience working with Provider network analytics strongly preferred.

• Healthcare contracting and claims data experience strongly preferred.

• Advanced Excel skills strongly preferred.

• Strong understanding of SQL preferred.

For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $89,936 - $134,904

Location: Mendota Heights, Minnesota

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

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 Are

Elevance 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 Work

At 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 and Influenza. 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.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.