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Provider Contract/Cost of Care Analyst Sr or Consultant - PS15795

Company: Anthem
Location: Monroe
Posted on: June 4, 2019

Job Description:

Provider Contract/Cost of Care Analyst Sr or Consultant - PS15795**Location:** **United States****New****Requisition #:** PS15795**Post Date:** 5 days agoYour Talent. Our Vision. **At Anthem, Inc.** , its a powerful combination, and the foundation upon which were 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, GANew York, NYRichmond, VAVirginia Beach, VAMinneapolis, MN**PROVIDER CONTRACT/COST OF CARE ANALYST SR****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. Typically works with one provider type, e.g. physician, ancillary, or medical group. Provides advice and analytic support to Medical Directors, contract negotiators and management on cost of care issues to help reduce costs without compromising quality of care.**Primary duties may include, but are not limited to:**1. Performs varied data analyses which may include: developing moderately complex ROI models and performs 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 analyses 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 proposals; researching the financial profitability/stability and competitive environment of providers to determine impact of proposed rates; and projecting 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. Participates on project team involved with enterprise wide initiatives.**PROVIDER CONTRACT/COST OF CARE CONSULTANT****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.2. Building new and modifying existing complex models to create predictive impact decision making tools.3. 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.4. Preparing pre-negotiation analysis to support development of defensible pricing strategies.5. 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.6. Researching the financial profitability/stability and competitive environment of providers to determine impact of proposed rates.7. Projects different cost of savings targets based upon various analytics.8. Identifies cost of care savings opportunities by analyzing practice patterns in relation to office visits, referral practices and specialty care procedures.8. Recommends policy changes and claim's system changes to pursue cost savings.9. Reviews results post-implementation to ensure projected cost savings are realized and recommends modifications as applicable.10. Recommends standardized practices to optimize cost of care.11. Educates provider contractors on contracting analytics from a financial impact perspective.12. May recommend alternative contract language and may go on-site to provider premises during contract negotiations.13. Participates on project team involved with enterprise wide initiatives.14. Acts as a source of direction, training and guidance for less experienced staff.**PROVIDER CONTRACT/COST OF CARE ANALYST SR** Requires a BS/BA degree in related field. 3-5 years data analysis or related experience. Any combination of education and experience, which would provide an equivalent background. 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. Payment Innovation/Provider Collaboration. Identifying healthcare drivers and trends. Healthcare revenue and claims data experience. Experience with relational databases and knowledge of query tools and statistical software is required. Ability to manipulate large sets of data is also required. Strong analytical, organizational and problem solving skills. This job is focused on complex and varied metrics, making recommendations and providing assistance to staff as compared to the Bus Info Analyst II job.**PROVIDER CONTRACT/COST OF CARE CONSULTANT** Requires a BS/BA degree in related field. Minimum of 5 years experience. 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. Payment Innovation/Provider Collaboration. Identifying healthcare drivers and trends. Healthcare revenue and claims data experience. Any combination of education and experience, which would provide an equivalent background. Experience with relational databases and knowledge of query tools and statistical software is required. Ability to manipulate large sets of data. Strong analytical, organizational, presentation, and problem solving skills. This job is more focused on higher level technical expertise, mentoring staff in lower job levels, more customer facing, higher level of collaboration, work is higher volume and/or higher risk, and modeling as compared to the Bus Info Analyst Sr job.An Equal Opportunity Employer/Disability/Veteran**Anthem, Inc. is ranked as one of Americas 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**

Keywords: Anthem, Monroe , Provider Contract/Cost of Care Analyst Sr or Consultant - PS15795, Professions , Monroe, Louisiana

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