Anthem, Inc. Provider Contract/Cost of Care Consultant in Miami Lakes, Florida
SHIFT: Day Job
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 care companies and a Fortune Top 50 Company.
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.
Preferred Locations - St. Louis, MO, Atlanta, GA, Chicago, IL, or Indianapolis, IN
Primary duties may include, but are not limited to:
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.
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 scenarios based on member utilization patterns and 'what if' logic working with various portfolio owners; researching the financial profitability/stability and competitive environment of providers to determine impact of proposed cost saving ideas;
Identifies cost of care savings opportunities by analyzing monthly financial trends in relations to unit costs , utilizations and case mix.
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.
Participates on project team involved with enterprise wide initiatives.
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; or any combination of education and experience, which would provide an equivalent background.
Experience with SQL, ideally Teradata
Data Extraction experience.
Health care industry experience
Experience working with contracting and medical management team strongly preferred.
Master's degree preferred.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.