Anthem Provider Contract/Cost of Care Consultant - 125759SK in Sacramento, California

Your Talent. Our Vision.At Anthem, Inc.,it’s a powerful combination, and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. Join us andtogether 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:

Virginia Beach or Norfolk, VA

Mason, OH

St. Louis, MO

Minnetonka, MN

Chicago, IL

Other Locations:

Richmond, VA

Thousand Oaks or Woodland Hills, CA

Denver, CO

New York City, NY

Columbia, MD

Wallingford, CT

Atlanta, GA

May consider other Anthem office locations

Job Summary:

Provides 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. Works on 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. Can work with multiple provider types, e.g. physician, ancillary, medical groups, or hospitals. Supports a full range of contract arrangements and pricing mechanisms. Works on complex enterprise-wide initiatives and acts as project lead.

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; building new and modifying existing complex 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 pre-negotiation analysis to support 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; 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.

  2. 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. Participates on project team involved with enterprise wide initiatives.

  8. Acts as a source of direction, training and guidance for less experienced staff.

    • 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.

    • Experience in Value-Based Arrangements is strongly preferred.

    • 3 years of SQL and/or SAS experience required, SAS experience strongly preferred.

    • Intermediate Excel skills required - Ability to create pivot tables, complex graphs, use VLOOKUP and HLOOKUP, as well as nested IF statements and mathematical equations.

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/Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran./

Job Reporting & Data Analysis

Title: Provider Contract/Cost of Care Consultant - 125759SK

Location: california-Sacramento

Requisition ID: 125759