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.
Preferred Office Locations:
Richmond, Virginia Beach or Norfolk, VA
PROVIDER CONTRACT/COST OF CARE CONSULTANT SR
Provides the highest level of analytical support to the Cost of Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider network satisfaction. Provides expert advice, analytic and consultative support to Medical Directors and management on cost of care issues. Leads large scale initiatives with high dollar cost savings opportunities. Partners with provider contractors to develop contracting strategy and supports all aspects of the contract negotiation process. Works with multiple provider types including the most complex, high profile providers. Supports a full range of contract arrangements and pricing mechanisms including the most complex contract terms. Works on the most complex, large scale enterprise wide initiatives and acts as project lead. Acts as a strategic partner to management.
Primary duties may include, but are not limited to:
1. Uses analytic tools to: track both health risks and compliance, as well as supporting the contract negotiation process. Types of analyses include performing sophisticated retrospective data analytics; developing the most complex new models and modifies existing models to create predictive impact decision making tools; performing 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 complex pre-negotiation analyses to support development of defensible pricing strategies; performing modeling to compare various contract scenarios based on member utilization patterns and 'what if'; measuring and evaluating the cost impact of various negotiation; researching the financial profitability/stability and competitive environment of providers to determine impact of proposed rates; and projects different cost of savings targets based upon various analytics.
2. 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.
3. Reviews results post-implementation to ensure projected cost savings are realized and recommends modifications as applicable.
4. Recommends standardized practices to optimize cost of care.
5. Educates provider contractors on contracting analytics from a financial impact perspective.
6. May recommend alternative contract language and may go on-site to provider premises during contract negotiations.
7. Researches providers' financial profitability/stability and competitive environment to determine impact of proposed rates.
8. Communicates fee strategies to manage provider expectations.
9. Provides on-going analytic and consultative support during complex and the most intense provider negotiations.
10. Educates provider contractors on contracting analytics from a financial impact perspective.
11. May recommend alternative contract language.
12. May go on-site to provider premises during contract negotiations.
13. Acts as a source of direction, training and guidance for less experienced staff.
14. Looks for continuous quality improvements and finds better ways to accomplish end results.
15. Works side by side with their manager.
- Requires BA/BS degree in Mathematics, Statistics or related field.
- 7+ years experience in broad-based analytical, managed care payor or provider environment; in depth experience in statistical analysis and modeling.
- Any combination of education and experience, which would provide an equivalent background.
- Experience providing leadership in evaluating and analyzing complex initiatives required.
- Medicare pricing experience.
- Master's degree preferred.
- Problem solving skills.
- Agile required.
- Healthcare data analytics experience.
- Access required.
- Excel required.
- Data modeling experience.Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 Diversity Inc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. An Equal Opportunity Employer/Disability/Veteran