Provider Contract/Cost of Care Consultant Sr - Health Economics
Company: Anthem, Inc
Location: Hampton
Posted on: February 20, 2021
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Job Description:
Description SHIFT: Day JobSCHEDULE: Full-timeYour Talent. Our
Vision. At Anthem, Inc., it is a powerful combination, and the
foundation upon which we are 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 -
PS38582 Location: Preferred Virginia, Ilinois, Indiana, Florida,
and Georgia. This position is a work at home opportunity and other
locations will be considered. Description: 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. Responsibilities: --- 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. --- 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. --- Reviews results post-implementation to
ensure projected cost savings are realized and recommends
modifications as applicable. --- Recommends standardized practices
to optimize cost of care. --- Educates provider contractors on
contracting analytics from a financial impact perspective. --- May
recommend alternative contract language and may go on-site to
provider premises during contract negotiations. --- Researches
providers' financial profitability/stability and competitive
environment to determine impact of proposed rates. --- Communicates
fee strategies to manage provider expectations. --- Provides
on-going analytic and consultative support during complex and the
most intense provider negotiations. --- Educates provider
contractors on contracting analytics from a financial impact
perspective. --- May recommend alternative contract language. ---
May go on-site to provider premises during contract negotiations.
--- Acts as a source of direction, training and guidance for less
experienced staff. --- Looks for continuous quality improvements
and finds better ways to accomplish end results. --- Works side by
side with their manager. Requirements: --- 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; or any
combination of education and experience, which would provide an
equivalent background. --- Experience working on Capitation
Reimbursement Analysis and Financial Modeling. --- Experience
providing leadership in evaluating and analyzing complex
initiatives required. --- Master's degree 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 - provided by Dice
Keywords: Anthem, Inc, Hampton , Provider Contract/Cost of Care Consultant Sr - Health Economics, Healthcare , Hampton, Virginia
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