Provider Contract/Cost of Care Consultant Sr

Company: Anthem, Inc
Location: New Haven
Posted on: August 1, 2020

Job Description:

Description SHIFT Day Job SCHEDULE Full-time Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and the foundation upon which we're creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company. Provider Contract Cost of Care Consultant Sr (Health Economics) PS36191 Preferred Work Location Wallingford, CT Will consider other locations such as Atlanta, GA Mason, OH, Indianapolis, IN Provides analytical support to the Cost of Care andor Provider Contracting organizations. Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider network satisfaction. Typically works with one provider type, e.g. physician, ancillary, or medical group. Provides advice and analytic support to Medical Directors, contract negotiators and management on cost of care issues to help reduce costs without compromising quality of care. Primary duties may include, but are not limited to bull Performs varied data analyses which may include developing moderately complex ROI models and performs healthcare cost analysis to identify strategies to control costs projecting cost increases in medical services by using analytic techniques for PMPM trending via multiple variable analysis preparing pre-negotiation analyses to support bull development of defensible pricing strategies performing modeling to compare various contract scenarios based on member utilization patterns and 'what if' logic measuring and evaluating the cost impact of various negotiation proposals researching the financial profitabilitystability and competitive environment of providers to determine impact of proposed rates and projecting different cost of savings targets based upon various analytics. bull 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. bull Reviews results post-implementation to ensure projected cost savings are realized and recommends modifications as applicable. bull Recommends standardized practices to optimize cost of care. bull Educates provider contractors on contracting analytics from a financial impact perspective. bull May recommend alternative contract language and may go on-site to provider premises during contract negotiations. bull Participates on project team involved with enterprise wide initiatives. Requirements bull Requires BSBA degree in Mathematics, Statistics, Computer Science or related field. bull 3-5 years' experience in broad-based analytical, managed care payor or provider environment considerable experience in statistical analysis and healthcare modeling required. Master's degree preferred. bull Any combination of education and experience, which would provide an equivalent background. bull 5 years of Health care claims data experience required, including developing queries, programs, reports and advanced analytical modeling. bull 5 years of developing queries and analysis using SAS, SQL required. bull MS Office required. bull Tableau and Hadoop experience preferred. bull Experience implementing and supporting alternate reimbursement methodologies strongly preferred. bull Business Analyst experience, including defining, documenting reporting and analytic system requirements, managing system testing, and validation activities strongly preferred. Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2018 Diversity Inc. magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at Careers.antheminc.com An Equal Opportunity EmployerDisabilityVeteran

Keywords: Anthem, Inc, New Haven , Provider Contract/Cost of Care Consultant Sr, Other , New Haven, Connecticut