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Provider Contract/Cost of Care Consultant or Sr – PS16059

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Reporting & Data Analysis
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PS16059 Requisition #

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 Locations:
Atlanta, GA
Richmond, VA
Manchester, NH
Denver, CO
Woodland Hills, CA

Job Summary:

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 effective management of unit price trends. Leads large scale initiatives with high dollar cost savings opportunities. 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. Manages the defects, enhancements and product roadmap for departmental trend tracking model.
3. Develops monthly reporting that is reviewed by executive leadership to support decision making around provider cost trends.
4. Reviews results post-implementation to ensure projected cost savings are realized and recommends modifications as applicable.
5. Recommends standardized practices to optimize cost of care.
6. Educates provider contractors on contracting analytics from a financial impact perspective.
7. May recommend alternative contract language.
8. Researches providers' financial profitability/stability and competitive environment to determine impact of proposed rates.
9. Communicates fee strategies to manage provider expectations.
10. Provides on-going analytic and consultative support during complex and the most intense provider negotiations.
11. Acts as a source of direction, training and guidance for less experienced staff.
12. Looks for continuous quality improvements and finds better ways to accomplish end results.
13. Works closely with local analysts and key business partners to ensure the validity of results
14. Works side by side with their manager.

Qualifications:

PROVIDER CONTRACT/COST OF CARE CONSULTANT


• Requires BS/BA degree in Mathematics, Statistics, or related field.
• Minimum of 5 years’ experience in broad based analytical, managed care payor or provider environment; considerable experience in statistical analysis and healthcare modeling.
• Any combination of education and experience, which would provide an equivalent background.
• Master's degree preferred.

PROVIDER CONTRACT/COST OF CARE CONSULTANT SR


• 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.
• Master's degree preferred.

QUALIFICATIONS FOR ALL LEVELS:


• Trend analysis and forecasting experience required
• Project Management experience and/or Analytical Product Development experience required.
• Knowledge of Agile development process preferred.
• Consulting experience required.
• SQL experience required.
• Presentation skills required.
• SAS, Tableau, VBA, ASP.NET experience preferred.
• Healthcare experience 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 Employer/Disability/Veteran

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