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Provider Contract/Cost of Care Consultant Sr – Health Economics

Anthem, Inc

This is a Full-time position in Hampton, VA posted February 23, 2021.

Description SHIFT Day Job SCHEDULE Full-time Your 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 ContractCost 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 andor 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 bull Uses analytic tools to track both health risks and compliance, as well as supporting the contract negotiation process. bull 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 profitabilitystability and competitive environment of providers to determine impact of proposed rates and projects 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 Researches providers’ financial profitabilitystability and competitive environment to determine impact of proposed rates. bull Communicates fee strategies to manage provider expectations. bull Provides on-going analytic and consultative support during complex and the most intense provider negotiations. bull Educates provider contractors on contracting analytics from a financial impact perspective. bull May recommend alternative contract language. bull May go on-site to provider premises during contract negotiations. bull Acts as a source of direction, training and guidance for less experienced staff. bull Looks for continuous quality improvements and finds better ways to accomplish end results. bull Works side by side with their manager. Requirements bull Requires BABS 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. bull Experience working on Capitation Reimbursement Analysis and Financial Modeling. bull Experience providing leadership in evaluating and analyzing complex initiatives required. bull 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 EmployerDisabilityVeteran